PHOENIX RECOVERY CENTER INC (NPI# 1417006503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417006503 |
| Entity Type | Organization |
| Organization Name | PHOENIX RECOVERY CENTER INC |
| Practice Address |
107 Edgewood Rd Edgewood MD 21040 |
| Practice Telephone | 4106717374 |
| Practice Fax Number | 4106797757 |
| Mailing Telephone | 4106717374 |
| Mailing Fax Number | 4106797757 |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-06-10 |
| Authorized Official Name | MR. ROBERT KINNEBERG (DIRECTOR) |
| Authorized Official Telephone | 4106717374 |
| Authorized Official Credential | MHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
13137 | MD | Ambulatory Health Care Facilities |
| Street Address |
107 EDGEWOOD RD |
| City | EDGEWOOD |
| State | MD |
| Zip Code | 21040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275028458 | Alycia Covelly | Counselor | 2415 Willoughby Beach Rd, Edgewood, MD 21040 | 2018-06-29 |
| 1558885491 | Kenneth J Heil Jr. | Physical Therapist | 1401f Pulaski Highway, Edgewood, MD 21040 | 2017-08-02 |
| 1952845810 | Caroline Njane | Registered Nurse | 835 Clover Leaf Ct, Edgewood, MD 21040 | 2016-12-12 |
| 1003368945 | Rts Edgewood | Clinic/Center | 2205 Pulaski Hwy, Edgewood, MD 21040 | 2016-10-26 |
| 1194133033 | Dante Winter | Pharmacist | 1301 Woodbridge Center Way, Edgewood, MD 21040 | 2014-07-23 |
| 1841469723 | Rafiq Patel M D P A | General Practice | 1952 Pulaski Highway, Edgewood, MD 21040 | 2008-02-26 |
| 1871793877 | Nichols Shelter Home for Elderly | Health Maintenance Organization | 1111 Hanson Rd., Edgewood, MD 21040 | 2007-07-19 |
| 1467505362 | William N Bernhard | Preventive Medicine | 2624 Fairview Pt Rd. Bldg E 6814, Aviation Medicine Clinic, Edgewood (apg), MD 21040 | 2007-01-22 |
| 1093886848 | Fernando Jose Narava | Dentist | 9690 Deereco, Suite 120, Timonium, MD 21040 | 2006-11-13 |
| 1912099722 | Rolando Glen Naraval | Dentist | 9690 Deereco Rd, Suite 120, Timonium, MD 21040 | 2006-09-29 |
| Find all providers in zip 21040 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619460367 | Project Chesapeake, LLC | Clinic/Center | 1308 Business Center Way Ste 102, Edgewood, MD 21040-1504 | 2018-06-07 |
| 1467850321 | Nalty & Associates Inc. | Clinic/Center | 1837 Pulaski Highway, Edgewood, MD 21040 | 2014-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043817075 | Maryland Community Health Initiatives, Inc. | Clinic/Center | 2648 Guilford Ave Apt 1fl, Baltimore, MD 21218-4611 | 2020-10-02 |
| 1851998892 | Maryland Community Health Initiatives, Inc. | Clinic/Center | 2648 Guilford Ave Apt 2fl, Baltimore, MD 21218-4611 | 2020-10-02 |
| 1801403324 | Maryland Community Health Initiatives, Inc. | Clinic/Center | 328 E 26th St, Baltimore, MD 21218-4702 | 2020-09-29 |
| 1275148975 | Hel Recovery Center | Clinic/Center | 1900 N Howard St Fl 2, Baltimore, MD 21218-5909 | 2020-09-10 |
| 1497365654 | Inspiring Change Mental Health Services, LLC. | Clinic/Center | 4654 York Rd Ste 1, Baltimore, MD 21212-4726 | 2020-08-03 |
| 1174132518 | Sabinas House LLC | Clinic/Center | 3103 Mareco Ave, Baltimore, MD 21213-1619 | 2020-07-30 |
| 1134738909 | Sabinas House LLC | Clinic/Center | 2224 Dukeland St, Baltimore, MD 21216-2812 | 2020-07-28 |
| 1881203792 | Sabinas House LLC | Clinic/Center | 3325 Shannon Dr, Baltimore, MD 21213-1823 | 2020-07-27 |
| 1356950265 | Sabinas House LLC | Clinic/Center | 616 Wildwood Pkwy, Baltimore, MD 21229-1810 | 2020-07-27 |
| 1598374407 | Sabinas House LLC | Clinic/Center | 605 Springfield Ave, Baltimore, MD 21212-4832 | 2020-07-27 |
| Find all providers with the same taxonomy | ||||
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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.