PHOENIX DOMUS NPI 1336728724

NPI Information

  • NPI: 1336728724
  • Provider Name: PHOENIX DOMUS
  • Classification: Counselor - 101YA0400X
  • Specialization: Addiction (Substance Use Disorder)
  • Entity Type: Organization
  • Address: 114 BEECH AVE
    ALTOONA, PA
    ZIP 16601
  • Phone: (814) 502-5157

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NPI Details

PHOENIX DOMUS is an addiction (substance use disorder) counselor in Altoona, PA. PHOENIX DOMUS NPI is 1336728724. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

114 BEECH AVE
ALTOONA, PA
ZIP 16601-235
Phone: (814) 502-5157

The provider's authorized official is Gregory Alan Mcconnell .
The authorized official title is Program Manager and has the following contact phone number (814) 934-6513.

The enumeration date for this NPI number is 4/5/2021 and was last updated on 4/6/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YA0400XCounselorAddiction (Substance Use Disorder)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1077037MEDICAIDPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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