Basic Information
| Provider Information | |||||||||
| NPI: | 1568659084 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARP PHOENIX - CALDWELL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 257 BILTMORE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282542700 | ||||||||
| FaxNumber: | 8282541524 | ||||||||
| Practice Location | |||||||||
| Address1: | 257 BILTMORE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282542700 | ||||||||
| FaxNumber: | 8282541524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2007 | ||||||||
| LastUpdateDate: | 09/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | TAX | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8282542700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 8300550 | 05 | NC | MEDICAID |