Provider Demographics
NPI:1053128439
Name:PHOENIX PLACE
Entity type:Organization
Organization Name:PHOENIX PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCUS DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-752-6170
Mailing Address - Street 1:4 CECELIA DR
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-1906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 CECELIA DR
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1906
Practice Address - Country:US
Practice Address - Phone:513-752-6170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)