1366820318 NPI number — PHOENIX HOME CARE, LLC

Table of content: (NPI 1366820318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366820318 NPI number — PHOENIX HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX HOME CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHOENIX HOME CARE AND HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366820318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3450 N. ROCK RD.
Provider Second Line Business Mailing Address:
#213, ATTN: DEBRA MULLEN
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67226-1352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-688-5511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14220 E 42ND ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-4726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-373-7442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HERMAN
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT & SECRETARY
Authorized Official Telephone Number:
316-688-5511

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com