Provider Demographics
NPI:1861739054
Name:PHOENIX SERVICES, INC.
Entity type:Organization
Organization Name:PHOENIX SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN, BC
Authorized Official - Phone:610-717-5722
Mailing Address - Street 1:83 S COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8934
Mailing Address - Country:US
Mailing Address - Phone:610-717-5722
Mailing Address - Fax:610-750-7167
Practice Address - Street 1:83 S COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8934
Practice Address - Country:US
Practice Address - Phone:610-717-5722
Practice Address - Fax:610-750-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACER-00051230261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100003909OtherMASTER PROVIDER INDEX (MPI)