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RWI891041A John Phoenix APRN, PLLC (Terminated)
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Main Details
Name
John Phoenix APRN, PLLC
Subdivision Name
Type
Ryan White Part A
340B ID
RWI891041A
Grant Number
H89HA06900
Additional Details
Current Program Status
Terminated
Registration Date
1/3/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/20/2020
Last Recertification Date
Time Period the Assistance was Received
Termination Date
Termination Reason
4/1/2021
Failure to recertify
Contacts
Authorizing Official
John Phoenix APRN PLLC dba Huntridge Family Clinic
John Phoenix, Chief Clinical Officer
(702) 979-1111
Primary Contact
John Phoenix APRN PLLC
Vanessa Rodriquez, Office Administrator
(702) 979-1111 Ext: 109
Addresses
Street Address
The Gay and Lesbian Center of Southern Nevada
401 S. Maryland Parkway
Las Vegas, NV 89101
Billing Address
John Phoenix APRN PLLC
1830 E. Sahara Ave
Suite 201
Las Vegas, NV 89104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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