PHOENIX HOUSES OF THE MID ATLANTIC, INC. (NPI# 1871995126) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871995126 |
| Entity Type | Organization |
| Organization Name | PHOENIX HOUSES OF THE MID ATLANTIC, INC. |
| Other Organization Name | DEMETER HOUSE |
| Practice Address |
4317 6th St S Confidential Address for Safety Reasons Do Not Publish Arlington VA 22204-1411 |
| 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 | 2014-09-18 |
| Last Update Date | 2014-09-18 |
| Authorized Official Name | MS. SUSAN HARGREAVES (VP & 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 | 324500000X | Substance Abuse Rehabilitation Facility | 122-01-007 | VA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | NPI | 1558415968 | 01 |
| VA | 004945051 | 05 | |
| MD | 4227751-00 | 05 |
| Other Name | Type Code |
|---|---|
| Demeter House | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023417086 | Phoenix Houses of The Mid Atlantic, Inc. | Substance Abuse Rehabilitation Facility | 3100 Arlington Blvd, Arlington, VA 22204-1816 | 2014-08-15 |
| 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 |
4317 6TH ST S CONFIDENTIAL ADDRESS FOR SAFETY REASONS DO NOT PUBLISH |
| City | ARLINGTON |
| State | VA |
| Zip Code | 22204-1411 |
| 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 |
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| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
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|---|---|---|---|---|
| 1619514957 | Volunteers of America Chesapeake, Inc. | Substance Abuse Rehabilitation Facility | 1554 Columbia Pike, Arlington, VA 22204-4667 | 2019-12-05 |
| 1326699927 | Caron Marc LLC | Substance Abuse Rehabilitation Facility | 4600 Fairfax Dr Ste 906, Arlington, VA 22203-1553 | 2019-09-25 |
| 1265891006 | Phoenix Houses of The Mid-atlantic, Inc | Substance Abuse Rehabilitation Facility | 521 N Quincy St, Arlington, VA 22203-2136 | 2016-02-22 |
| 1801129754 | Stillaguamish Tribe of Indians | Substance Abuse Rehabilitation Facility | 21123 Smokey Point Blvd, Arlington, WA 98223-4224 | 2009-09-10 |
| 1568612679 | Darryl Glen Funk | Substance Abuse Rehabilitation Facility | 521 N Quincy St, Arlington, VA 22203-2136 | 2008-09-25 |
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| 1740766161 | Community Wellness & Support, LLC | Substance Abuse Rehabilitation Facility | 34 Medical Park Blvd Ste A, Petersburg, VA 23805-9283 | 2018-07-18 |
| 1548780869 | A. Richards Counseling & Psychotherapy, LLC | Substance Abuse Rehabilitation Facility | 720 Rodman Ave., Portsmouth, VA 23707 | 2017-06-27 |
| 1710418447 | Phc of Virginia, LLC | Substance Abuse Rehabilitation Facility | 120 Roanoke Blvd, Salem, VA 24153-4908 | 2017-03-24 |
| 1699135244 | Center for Behavioral Health LLC | Substance Abuse Rehabilitation Facility | 13885 Hedgewood Dr Ste 349, Woodbridge, VA 22193-7933 | 2016-02-24 |
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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.