Provider Demographics
NPI:1851014534
Name:PHOENIX & THE BUTTERFLY RECOVERY INC
Entity type:Organization
Organization Name:PHOENIX & THE BUTTERFLY RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLEMIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:443-845-9280
Mailing Address - Street 1:2121 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-1335
Mailing Address - Country:US
Mailing Address - Phone:410-963-1717
Mailing Address - Fax:
Practice Address - Street 1:2121 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-1335
Practice Address - Country:US
Practice Address - Phone:410-963-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility