Provider Demographics
NPI:1316310949
Name:PHOENIX HOUSE OF NEW ENGLAND
Entity type:Organization
Organization Name:PHOENIX HOUSE OF NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MLADC
Authorized Official - Phone:603-358-4041
Mailing Address - Street 1:12 KINGSBURY ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3825
Mailing Address - Country:US
Mailing Address - Phone:603-358-4041
Mailing Address - Fax:603-352-4738
Practice Address - Street 1:12 KINGSBURY ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3825
Practice Address - Country:US
Practice Address - Phone:603-358-4041
Practice Address - Fax:603-352-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0837324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility