Provider Demographics
NPI:1306259932
Name:PHOENIX HOUSES OF TEXAS, INC
Entity type:Organization
Organization Name:PHOENIX HOUSES OF TEXAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BART
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-920-1628
Mailing Address - Street 1:1910 PACIFIC AVE STE 10500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4591
Mailing Address - Country:US
Mailing Address - Phone:214-920-1628
Mailing Address - Fax:214-351-0967
Practice Address - Street 1:211 COMMERCE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2184
Practice Address - Country:US
Practice Address - Phone:512-541-6097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX865-865M261QM1300X
TX865-865P261QM1300X
TX865-3572261QR0405X
TX865-3340261QR0405X
TX865-3729261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335999401Medicaid
TX065459201Medicaid
TX170251601Medicaid
TX319371601Medicaid
TX330736501Medicaid