PHOENIX RECOVERY CENTER INC NPI 1417006503

NPI Information

  • NPI: 1417006503
  • Provider Name: PHOENIX RECOVERY CENTER INC
  • Classification: Clinic/Center - 261QR0405X
  • Specialization: Rehabilitation, Substance Use Disorder
  • Entity Type: Organization
  • Address: 107 EDGEWOOD RD
    EDGEWOOD, MD
    ZIP 21040
  • Phone: (410) 671-7374

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NPI Details

PHOENIX RECOVERY CENTER INC is a rehabilitation and substance use disorder clinic center in Edgewood, MD. PHOENIX RECOVERY CENTER INC NPI is 1417006503. The provider is registered as an organization entity type.

The provider's business location address is:

107 EDGEWOOD RD
EDGEWOOD, MD
ZIP 21040
Phone: (410) 671-7374
Fax: (410) 679-7757

The provider's authorized official is Robert Kinneberg .
The authorized official title is Director and has the following contact phone number (410) 671-7374.

The enumeration date for this NPI number is 1/9/2007 and was last updated on 6/10/2020.

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
1261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
2261QR0405XClinic/CenterRehabilitation, Substance Use Disorder13137MARYLANDYes

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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