PHOENIX HOUSES OF TEXAS INC NPI 1508992249

NPI Information

NPI: 1508992249
Provider Name: PHOENIX HOUSES OF TEXAS, INC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 45D2070123

Address:
2345 REAGAN ST
DALLAS, TX
ZIP 75219
Phone: (214) 999-1044
Get Directions

PHOENIX HOUSES OF TEXAS, INC is a multi-specialty clinic center in Dallas, TX. PHOENIX HOUSES OF TEXAS, INC NPI is 1508992249. The provider is registered as an organization entity type.

The provider's business location address is:

2345 REAGAN ST
DALLAS, TX
ZIP 75219-225
Phone: (214) 999-1044
Fax: (214) 526-3285

The provider's authorized official is Bart R Loewen .
The authorized official title is President & Ceo and has the following contact phone number (214) 920-1628.

The CLIA number assigned to this NPI record is 45D2070123 - other - substance abuse treatment with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/26/2007 and was last updated on 12/20/2022.

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
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			No
2	261QM1300X	Clinic/Center	Multi-Specialty	865	TEXAS	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
1	170251601	MEDICAID	TEXAS
2	865-865M	OTHER		STATE OF TEXAS
3	865-865P	OTHER		STATE OF TEXAS
4	065459201	MEDICAID	TEXAS
5	319371601	MEDICAID	TEXAS
6	335999401	MEDICAID	TEXAS

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: 4/28/2024

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