Provider Demographics
NPI:1144861972
Name:PHOENIX RISING ADDCITION CENTER INC.
Entity type:Organization
Organization Name:PHOENIX RISING ADDCITION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEAIAKALA
Authorized Official - Suffix:III
Authorized Official - Credentials:LAADC
Authorized Official - Phone:949-463-8381
Mailing Address - Street 1:18 PIARA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1821
Mailing Address - Country:US
Mailing Address - Phone:949-463-8381
Mailing Address - Fax:
Practice Address - Street 1:26072 MERIT CIR STE 104
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7015
Practice Address - Country:US
Practice Address - Phone:949-463-8381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty