Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

PHOENIX GROUP HOME, LLC
Complete NPI Record 1083146013
Community/Behavioral Health in Portsmouth, OH

Name: Complete NPI 1083146013 Record Table
Creator: NPI Profile
License: https://www.cms.gov/data-research/cms-data/data-available-everyone

Active since March 29, 2017CLIA Certified · 38 labs

902 GALLIA ST, PORTSMOUTH, OH 45662(740) 529-2125(740) 529-2126 Get Directions

NPPES record last updated: August 17, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Aug 17, 2026, Nov 12, 2024, Sep 24, 2024 and 3 more (6 updates tracked since 2017).

Complete NPI Dataset

This page contains the complete raw NPPES record for Phoenix Group Home, Llc (NPI 1083146013), a community/behavioral health organization in Portsmouth, OH. All 36 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

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Registry File Document Utilities

NPI: 1083146013: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: PHOENIX GROUP HOME, LLC: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: Not available: Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 6: Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 257 E 200 S STE 350: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: SALT LAKE CITY: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: UT: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 841112085: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 7408581659: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 5132212093: The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 902 GALLIA ST: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: PORTSMOUTH: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OH: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 456624139: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7405292125: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7405292126: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 3/29/2017: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/17/2026: The date that a record was last updated or changed.
Authorized Official Last Name: LUNT: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MARSHAL: The first name of the authorized official.
Authorized Official Title or Position: OWNER: The title or position of the authorized official.
Authorized Official Telephone Number: 8015603822: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 251S00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 2: 3245S0500X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 2: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Other Provider Identifier 1: 0241576: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 1: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 1: OH: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Is Organization Subpart: N: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Authorized Official Name Prefix Text: MR.: The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
NPI Certification Date: 8/17/2026: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Other Organization Names 3

Additional business and trade names this provider has on file with the NPPES registry.

PATH Integrated Healthcare Doing Business As

1/3

Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.

Path Behavioral Healthcare Doing Business As

2/3

Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.

Path Integrated Health Doing Business As

3/3

Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.

Secondary Practice Locations 39

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

31500 Chieftain Dr Unit Bc

1/39

Logan, OH 43138-8421 · Phone (740) 270-3286

8237 Hayport Rd # 3&4

2/39

Wheelersburg, OH 45694-1781 · Phone (740) 270-3534

905 N Main St

3/39

Findlay, OH 45840-3670 · Phone (567) 525-4100

632 Wagner Ave

4/39

Greenville, OH 45331-2649 · Phone (937) 365-2275

213 Dayton St

5/39

Hamilton, OH 45011-1633 · Phone (513) 275-6447

411 Center St

6/39

Ironton, OH 45638-1506 · Phone (740) 302-8370

303 Offnere St

7/39

Portsmouth, OH 45662-4655 · Phone (740) 715-0094

5439 Burkhardt Rd

8/39

Riverside, OH 45431-2111 · Phone (937) 791-1440

2057 S Limestone St

9/39

Springfield, OH 45505-4727 · Phone (937) 226-9787

126 N Cross St

10/39

West Union, OH 45693-1209 · Phone (740) 340-1460

9711 E Pike Rd Rm 104

11/39

Cambridge, OH 43725-8936 · Phone (740) 825-8543

1616 E Liberty St Ste B

12/39

Girard, OH 44420-2490 · Phone (330) 919-1595

1621 Tiffin Ave

13/39

Findlay, OH 45840-6848 · Phone (567) 525-4100

10 Myrtle Ave

14/39

Gallipolis, OH 45631-9772 · Phone (740) 208-7462

1404 N High St

15/39

Hillsboro, OH 45133-8692 · Phone (740) 400-0411

3044 Columbus Lancaster Rd NW

16/39

Lancaster, OH 43130-8125 · Phone (740) 883-9300

111 W Water St

17/39

Chillicothe, OH 45601-2452 · Phone (740) 851-6493

3012 Glenmore Ave Ste 104

18/39

Cincinnati, OH 45238-2258 · Phone (513) 914-1815

1475 Lexington Ave Ste A

19/39

Mansfield, OH 44907-2687 · Phone (419) 386-0954

1713 Marion Mount Gilead Rd Ste 108

20/39

Marion, OH 43302-7868 · Phone (740) 396-9970

399 Lincoln Park Dr Ste A

21/39

New Lexington, OH 43764-1078 · Phone (740) 960-0380

9 Chesapeake Plz

22/39

Chesapeake, OH 45619-1003 · Phone (740) 340-1602

11201 Shaker Blvd Ste 102

23/39

Cleveland, OH 44104-3833 · Phone (216) 758-4120

7211 N Main St

24/39

Dayton, OH 45415-2566 · Phone (937) 791-1427

188 W Hebble Ave

25/39

Fairborn, OH 45324-4960 · Phone (937) 754-5911

1235 W Market St

26/39

Lima, OH 45805-2728 · Phone (567) 289-6060

419 Vernon St

27/39

Ironton, OH 45638-1637 · Phone (740) 479-5120

336 E Main St

28/39

Jackson, OH 45640-1718 · Phone (740) 688-2586

757 Columbus Ave

29/39

Lebanon, OH 45036-1607 · Phone (513) 836-8230

53 W Main St Ste 53

30/39

Xenia, OH 45385-2979 · Phone (937) 971-2350

379 Adair Ave

31/39

Zanesville, OH 43701-2915 · Phone (740) 297-6019

1156 Columbus Ave Ste C

32/39

Washington Court House, OH 43160-2612 · Phone (740) 895-5900

221 W Emmitt Ave Unit 1

33/39

Waverly, OH 45690-1005 · Phone (740) 865-4054

49 Johnson Rd

34/39

The Plains, OH 45780-1146 · Phone (740) 764-5429

701 Hildreth Ln

35/39

Marietta, OH 45750-1768 · Phone (740) 371-7194

151 S Kennebec Ave

36/39

McConnelsville, OH 43756-1211 · Phone (740) 960-0568

4384 Rhodes Ave

37/39

New Boston, OH 45662-5533 · Phone (740) 566-5600

220 S Breiel Blvd Ste 220B

38/39

Middletown, OH 45044-5166 · Phone (513) 849-8670

1605 11th St

39/39

Portsmouth, OH 45662-4525 · Phone (740) 883-9321

Other Provider Identifiers 1

Legacy and payer-issued identifiers reported to the NPPES registry for this provider.

0241576 Medicaid

1/1

State: OH
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

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