PHOENIX HOUSES OF THE MID ATLANTIC, INC. (NPI# 1023417086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023417086 |
| Entity Type | Organization |
| Organization Name | PHOENIX HOUSES OF THE MID ATLANTIC, INC. |
| Other Organization Name | GIRLS RECOVERY LODGE |
| Practice Address |
3100 Arlington Blvd Arlington VA 22204-1816 |
| Mailing Address |
200 N Glebe Rd Suite 104 Arlington VA 22203-3728 |
| Practice Telephone | 7038410703 |
| Practice Fax Number | 7032430975 |
| Mailing Telephone | 7038410703 |
| Mailing Fax Number | 7032430975 |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2014-09-12 |
| Authorized Official Name | MS. SUSAN HARGREAVES (VICE PRESIDENT/ DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 7038410703 |
| Is Organization Subpart | Y |
| Parent Organization Name | PHOENIX HOUSE FOUNDATION, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
122-14-003 | VA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | NPI | 1558415968 | 01 |
| VA | 004945051 | 05 |
| Other Name | Type Code |
|---|---|
| Girls Recovery Lodge | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871995126 | Phoenix Houses of The Mid Atlantic, Inc. | Substance Abuse Rehabilitation Facility | 4317 6th St S, Confidential Address for Safety Reasons Do Not Publish, Arlington, VA 22204-1411 | 2014-09-18 |
| 1558415968 | Phoenix Houses of The Mid Atlantic, Inc. | Counselor | 521 N. Quincy Street, Arlington, VA 22203 | 2007-01-22 |
| 1861893703 | Phoenix Houses of The Mid Atlantic, Inc. | Community/Behavioral Health | 514 Crain Hwy N, Suite B, Glen Burnie, MD 21061-3063 | 2014-09-10 |
| 1700285087 | Phoenix Houses of The Mid Atlantic, Inc. | Community/Behavioral Health | 200 N Glebe Rd, Suite 104, Arlington, VA 22203-3728 | 2014-08-22 |
| Street Address |
3100 ARLINGTON BLVD |
| City | ARLINGTON |
| State | VA |
| Zip Code | 22204-1816 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639714157 | Cielito Home Health Services, LLC | Registered Nurse | 3708 3rd. Street South, Arlington, VA 22204 | 2019-11-07 |
| 1275177438 | Annie Rachel Poole | Occupational Therapist | 2301 Columbia Pike, Suite 125, Arlington, VA 22204 | 2019-10-31 |
| 1609426436 | Daniela Patricia Jaldin | Home Health Aide | 3708 3rd St. South, Arlington, VA 22204 | 2019-09-13 |
| 1124581475 | Lisa Nemeth | Psychologist | 2110 Washington Bvld, Office of Student Services, Arlington, VA 22204 | 2019-04-12 |
| 1568946176 | Barcroft Dentistry | Dentist | 939 S. Wakefield St, Arlington, VA 22204 | 2018-09-19 |
| 1316431869 | Shannon Odom | Psychologist | Arlington Public Schools Child Find, 2110 Washington Blvd, Arlington, VA 22204 | 2018-06-19 |
| 1801301106 | Carla Janai Farley | Behavior Technician | 2726 N. Cleveland Street, Arlington, VA 22204 | 2017-12-08 |
| 1174064737 | Ezequiel Andrade Fuentes | Dentist | Calle Segunda #67, Ejido Mariano Matamoros, Tijuana, BAJA CALIFORNIA 22204 | 2017-03-15 |
| 1639583107 | Syeda Kutub | Optometrist | 1020 S Glebe Rd, Arlington, VA 22204 | 2014-06-12 |
| 1255769311 | Joyful Mind Counseling of Virginia | Home Health | 1804 B 9th St South, Arlington, VA 22204 | 2013-10-28 |
| Find all providers in zip 22204 | ||||
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | Substance Abuse Treatment, Children |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. |
| Notes: [7/1/2003: new] |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.