Provider Demographics
NPI:1285331496
Name:PHOS, INC
Entity type:Organization
Organization Name:PHOS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANGELOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-925-4651
Mailing Address - Street 1:15826 S LA GRANGE RD STE 122
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7793
Mailing Address - Country:US
Mailing Address - Phone:312-925-4651
Mailing Address - Fax:
Practice Address - Street 1:5724 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2359
Practice Address - Country:US
Practice Address - Phone:312-291-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)