Phoenix Residential Services

NPI #1912434770 in Pontiac, Michigan

Provider Information

NPI Number: 1912434770
Entity Type: Organization
Organization Name: Phoenix Residential Services
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: May 11, 2017
Last Updated: May 11, 2017

Practice Location

Address: 108 FRANKLIN BLVD
City: Pontiac
State: Michigan
ZIP Code: 48341-1706
Phone: (248) 338-3743

Authorized Official

Name: DEMETRA B LEONARD
Title: PRESIDENT
Phone: (248) 338-3743

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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