PHOENIX RECOVERY SERVICES, LLC (NPI# 1760506315) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760506315 |
| Entity Type | Organization |
| Organization Name | PHOENIX RECOVERY SERVICES, LLC |
| Practice Address |
1601 E College Way Mount Vernon WA 98273-5612 |
| Practice Telephone | 3608488437 |
| Practice Fax Number | 3608485250 |
| Mailing Telephone | 3608488437 |
| Mailing Fax Number | 3608485250 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. CAROL RUTH HUNDAHL (OWNER) |
| Authorized Official Telephone | 3608488437 |
| Authorized Official Credential | CDP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 29114900 | WA | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467763276 | Phoenix Recovery Services, LLC | Clinic/Center | 31640 Sr 20 Ste 1, Oak Harbor, WA 98277-3128 | 2010-06-25 |
| 1891208278 | Phoenix Recovery Services, LLC | Specialist | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2017-11-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PHOENIX RECOVERY SERVICES, LLC | 1601a E College Way, Mount Vernon, WA 98273 |
| Washington State Corporations | PHOENIX RECOVERY SERVICES, LLC | 1601 E College Way, Mount Vernon, WA 98273-5612 |
| Street Address |
1601 E COLLEGE WAY |
| City | MOUNT VERNON |
| State | WA |
| Zip Code | 98273-5612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578183109 | Shelly Marie Jones | Counselor | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2020-04-23 |
| 1396376737 | Shea Bradley English | Counselor | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2020-02-03 |
| 1285193979 | Phoenix Recovery House | Community/Behavioral Health | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2019-03-13 |
| 1811490774 | Jesus Antonio Bautista | Case Manager/Care Coordinator | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2018-03-16 |
| 1205341872 | Lori M Auriemma | Case Manager/Care Coordinator | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2017-12-05 |
| 1629583265 | Fighter for God | Case Manager/Care Coordinator | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2017-12-05 |
| 1124533765 | Terri Knowles | Case Manager/Care Coordinator | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2017-12-05 |
| 1750895561 | Vanessa Lopez | Case Manager/Care Coordinator | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2017-12-01 |
| 1902310725 | Emiliano Barajas Farias | Case Manager/Care Coordinator | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2017-12-01 |
| 1942714191 | Rebekah A Beardsley | Specialist | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2017-11-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710585849 | Stephanie Marie Partington | Physical Therapist | 1901 Hoad Road, Mount Vernon, WA 98273 | 2020-10-12 |
| 1447866165 | Jennifer I Campos | Interpreter | 1501 Sunset Pl., Unit B, Mount Vernon, WA 98273 | 2020-09-17 |
| 1487217345 | Nicholas Peter Goodman | Student in an Organized Health Care Education/Training Program | Attn: Internal Medicine Residency, 300 Hospital Parkway, Mount Vernon, WA 98273 | 2019-04-17 |
| 1023579430 | Joan Watkins Opyr | Registered Nurse | Telecare North Sound E&t, 7825 North Sound Drive, Sedro-woolley, WA 98273 | 2019-03-28 |
| 1588136188 | Nicholas Bryan Corp | Physical Therapy Assistant | 1901 Hoag Road, Mount Vernon, WA 98273 | 2018-12-20 |
| 1518437300 | Eyonna Mason | Case Manager/Care Coordinator | 1100 52nd St, Mount Vernon, WA 98273 | 2018-12-05 |
| 1023515400 | Evergreen Recovery Centers | Substance Abuse Rehabilitation Facility | 1905 Continental Place, Mount Vernon, WA 98273 | 2018-04-11 |
| 1104320480 | Stacy Anne Black | Marriage & Family Therapist | 2301 Old Hwy 99, Mt. Vernon, WA 98273 | 2018-03-21 |
| 1609387844 | Kerri Jesse | Massage Therapist | 210 N 23rd St, Mount Vernon, WA 98273 | 2017-10-16 |
| 1992225320 | Juana Cleek | Registered Nurse | 330 Pacific Place, Mount Vernon, WA 98273 | 2017-06-27 |
| Find all providers in zip 98273 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316508559 | Front Range Ranch & Rescue | Community/Behavioral Health | 27808 Widows Creek Rd, Mount Vernon, OR 97865-6152 | 2019-06-27 |
| 1437661006 | Spero Family Services | Community/Behavioral Health | 403 N 42nd St Ste C, Mount Vernon, IL 62864-2297 | 2017-11-03 |
| 1275906794 | The Guidance Center of Westchester | Community/Behavioral Health | 151 Chester St, Mount Vernon, NY 10552-3203 | 2015-11-05 |
| 1417339151 | Turning Point- Its Your Turn Inc | Community/Behavioral Health | 44 N Terrace Ave, Mount Vernon, NY 10550-1815 | 2015-06-18 |
| 1851427694 | Eric Richard Johnson | Community/Behavioral Health | 1330a S 2nd St Ste 102, Mount Vernon, WA 98273-4822 | 2007-02-26 |
| 1063562122 | Posey County Rehabilitation Services | Community/Behavioral Health | 5525 Industrial Rd, Mount Vernon, IN 47620-7200 | 2007-01-11 |
| 1861506974 | The Guidance Center of Westchester, Inc | Community/Behavioral Health | 256 Washington St, Mount Vernon, NY 10553-1052 | 2006-08-18 |
| 1871119768 | Psychiatric Nurse Consulting & Therapy, LLC | Community/Behavioral Health | 117 N 1st St Ste 55, Mount Vernon, WA 98273-2858 | 2020-06-17 |
| 1285193979 | Phoenix Recovery House | Community/Behavioral Health | 1601 E College Way, Mount Vernon, WA 98273-5612 | 2019-03-13 |
| 1174097547 | Awaken Licensed Applied Behavioral Analysis Services Pllc | Community/Behavioral Health | 40 E Sidney Ave Apt 5a, Mount Vernon, NY 10550-1420 | 2019-01-18 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 98273 |
Please comment or provide details below to improve the information on PHOENIX RECOVERY SERVICES, LLC.
| 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.