Phoenix Residential Centers, Inc.

NPI #1821429267 in Mentor, Ohio

Provider Information

NPI Number: 1821429267
Entity Type: Organization
Organization Name: Phoenix Residential Centers, Inc.
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Dec 11, 2013
Last Updated: Dec 11, 2013

Practice Location

Address: 5422 W HEISLEY RD
City: Mentor
State: Ohio
ZIP Code: 44060-1751
Phone: (440) 352-1105

Authorized Official

Name: MRS. MARY JO JASKELA
Title: CONTROLLER
Phone: (440) 428-9082

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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