Provider Demographics
NPI:1992884787
Name:PHOENIX HOUSES OF NEW ENGLAND, INC.
Entity type:Organization
Organization Name:PHOENIX HOUSES OF NEW ENGLAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-331-4250
Mailing Address - Street 1:99 WAYLAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4314
Mailing Address - Country:US
Mailing Address - Phone:401-331-4250
Mailing Address - Fax:401-421-5520
Practice Address - Street 1:99 WAYLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4314
Practice Address - Country:US
Practice Address - Phone:401-331-4250
Practice Address - Fax:401-421-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X, 1041C0700X, 106H00000X, 207QA0401X, 2084P0800X, 2084P0802X, 363A00000X, 363L00000X, 363LP0808X, 364SP0808X
RI621324500000X
NH02725324500000X
MA0296324500000X
RICMC 00028324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
410878OtherBC RI
RI9202OtherNHP RI
RI9515OtherNHP RI
ME15601000OtherMAINECARE
ME15601001OtherMAINECARE
203388OtherBC RI
RIMA04867Medicaid
6988OtherBC RI
30766OtherBC RI
VT1009585Medicaid
VT1006554Medicaid
VT1009358Medicaid
410875OtherBC RI
RI9203OtherNHP RI
VT1002232Medicaid
NH30007117Medicaid
30763OtherBC RI
467656OtherMOHEGAN SUN VALUE OPTIONS
RI9192OtherNHP RI
VT1009585Medicaid