Basic Information
Provider Information | |||||||||
NPI: | 1033347802 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ARP/PHOENIX, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | GASTONIA PREVENTION | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3060 PEACHTREE RD NW | ||||||||
Address2: | SUITE 900 | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303052234 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4043642900 | ||||||||
FaxNumber: | 4043642901 | ||||||||
Practice Location | |||||||||
Address1: | 901 S NEW HOPE RD | ||||||||
Address2: |   | ||||||||
City: | GASTONIA | ||||||||
State: | NC | ||||||||
PostalCode: | 280545829 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7048426314 | ||||||||
FaxNumber: | 7048544200 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/30/2009 | ||||||||
LastUpdateDate: | 06/30/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ORSINI | ||||||||
AuthorizedOfficialFirstName: | KAREN | ||||||||
AuthorizedOfficialMiddleName: | LYN | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT - FINANCIAL SERVICES | ||||||||
AuthorizedOfficialTelephone: | 4043642900 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MBA | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.