| Full Name | Phoenix Domus |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 114 Beech Ave, Altoona, Pennsylvania |
| Authorized Official Name and Position | Gregory Alan Mcconnell (PROGRAM MANAGER) |
| Authorized Official Contact | 8149346513 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Domus 114 Beech Ave Altoona PA 16601-4235 Ph: (814) 502-5157 | Phoenix Domus 114 Beech Ave Altoona PA 16601-4235 Ph: (814) 502-5157 |
| NPI Number | 1336728724 |
|---|---|
| Provider Enumeration Date | 04/05/2021 |
| Last Update Date | 04/06/2021 |
| Certification Date | 04/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336728724 | NPI | - | NPPES |
| 077037 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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