Provider Demographics
NPI:1114255619
Name:A-1 PHOENIX HEALTHCARE LLC
Entity Type:Organization
Organization Name:A-1 PHOENIX HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMAGPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-591-0110
Mailing Address - Street 1:1304 W WALNUT HILL LN STE 380
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2942
Mailing Address - Country:US
Mailing Address - Phone:214-591-0110
Mailing Address - Fax:214-591-0106
Practice Address - Street 1:1304 W WALNUT HILL LN STE 380
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2942
Practice Address - Country:US
Practice Address - Phone:214-591-0110
Practice Address - Fax:214-591-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health