Provider Demographics
NPI:1124165113
Name:PHOENIX INVESTMENTS GROUP, LLC
Entity type:Organization
Organization Name:PHOENIX INVESTMENTS GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-812-8115
Mailing Address - Street 1:508 QUARTZ DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6648
Mailing Address - Country:US
Mailing Address - Phone:919-812-8115
Mailing Address - Fax:919-957-8342
Practice Address - Street 1:508 QUARTZ DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6648
Practice Address - Country:US
Practice Address - Phone:919-812-8115
Practice Address - Fax:919-957-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-076-084251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418199Medicaid
NC8301745Medicaid