1336261361 NPI number — PHOENIX SERVICES, INC.

Table of content: (NPI 1336261361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336261361 NPI number — PHOENIX SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336261361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1655 VALLEY CENTER PKWY
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-2293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-893-5050
Provider Business Mailing Address Fax Number:
484-893-5051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 W PENN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEONA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-3230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-228-0400
Provider Business Practice Location Address Fax Number:
717-228-3929
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCFERREN
Authorized Official First Name:
DEVIN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
717-228-0400

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  305510 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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