| Phoenix Rising Wellness, Llc | |
|
10425 W North Ave Ste 311 Milwaukee WI 53226-2400 | |
| (414) 436-9918 | |
| Not Available |
| Full Name | Phoenix Rising Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10425 W North Ave Ste 311, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Carolyn Morris (OWNER) |
| Authorized Official Contact | 4144369918 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Wellness, Llc 10425 W North Ave Ste 311 Milwaukee WI 53226-2400 Ph: (414) 436-9918 | Phoenix Rising Wellness, Llc 10425 W North Ave Ste 311 Milwaukee WI 53226-2400 Ph: (414) 436-9918 |
| NPI Number | 1851053755 |
|---|---|
| Provider Enumeration Date | 10/07/2021 |
| Last Update Date | 06/29/2023 |
| Certification Date | 06/29/2023 |
| Medicare PECOS PAC ID | 5193114973 |
|---|---|
| Medicare Enrollment ID | O20211117000178 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851053755 | NPI | - | NPPES |
| Provider Name | Carolyn B Morris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811188964 PECOS PAC ID: 0345335311 Enrollment ID: I20071005000221 |
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