Provider Demographics
NPI:1386886240
Name:PHOENIXAOD, LTD
Entity type:Organization
Organization Name:PHOENIXAOD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ELSWICK
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:740-354-9607
Mailing Address - Street 1:242 LAFAYETTE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN FURNACE
Mailing Address - State:OH
Mailing Address - Zip Code:45629-9014
Mailing Address - Country:US
Mailing Address - Phone:740-354-9607
Mailing Address - Fax:740-354-9607
Practice Address - Street 1:242 LAFAYETTE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN FURNACE
Practice Address - State:OH
Practice Address - Zip Code:45629-9014
Practice Address - Country:US
Practice Address - Phone:740-354-9607
Practice Address - Fax:740-354-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health