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PHOENIX PLACE

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Company Details

Name: PHOENIX PLACE
Legal type: LP From Assumed Name
Status: Inactive
File Date: 14 Dec 1983 (42 years ago)
Organization Date: 14 Dec 1983 (42 years ago)
Organization Number: 0183079
Principal Office: % MCCORMACK, BARON & ASSOCIATES, 1101 RUCAS ST., 6TH. FLOOR, ST. LOUIS, MO 63101
Place of Formation: KENTUCKY

Registered Agent

Name Role
% MCCORMACK, BARON & ASSOCIATES Registered Agent

General Partner

Name Role
MCCORMACK, BARON & ASSOC General Partner
STEVEN J. STOGEL General Partner

National Provider Identifier

NPI Number:
1740065713
Certification Date:
2024-05-07

Authorized Person:

Name:
DIAMOND CALLOWAY
Role:
EXECUTIVE DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
101YA0400X - Addiction (Substance Use Disorder) Counselor
Is Primary:
No
Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
No
Selected Taxonomy:
3245S0500X - Children's Substance Abuse Rehabilitation Facility
Is Primary:
No
Selected Taxonomy:
251B00000X - Case Management Agency
Is Primary:
No
Selected Taxonomy:
251S00000X - Community/Behavioral Health Agency
Is Primary:
Yes

Contacts:

Assumed Names

Name Status Expiration Date
PHOENIX PLACE Inactive -

Filings

Name File Date
Certificate of Assumed Name 1983-12-14
Certificate of Assumed Name 1983-12-14

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Sources: Kentucky Secretary of State