Provider Demographics
NPI:1588346753
Name:PHOENIX RECOVERY HOMES
Entity type:Organization
Organization Name:PHOENIX RECOVERY HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KISEKKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-289-2180
Mailing Address - Street 1:961 W FOGAL WAY
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4727
Mailing Address - Country:US
Mailing Address - Phone:480-459-4936
Mailing Address - Fax:602-532-7076
Practice Address - Street 1:961 W FOGAL WAY
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4727
Practice Address - Country:US
Practice Address - Phone:480-459-4936
Practice Address - Fax:602-532-7076
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAMPIMA COTTAGE INVESTMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health