Provider Demographics
NPI:1609752963
Name:FAITHFUL PHOENIX EXPRESS
Entity type:Organization
Organization Name:FAITHFUL PHOENIX EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-374-5256
Mailing Address - Street 1:2219 WILLOWDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-2840
Mailing Address - Country:US
Mailing Address - Phone:216-374-5256
Mailing Address - Fax:
Practice Address - Street 1:3100 E 45TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1088
Practice Address - Country:US
Practice Address - Phone:216-417-4932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)