Provider Demographics
NPI:1235494246
Name:PHENIX ENTERPRISE SERVICES, LLC
Entity Type:Organization
Organization Name:PHENIX ENTERPRISE SERVICES, LLC
Other - Org Name:HELPING HANDS PRIVATE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGERS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-845-9313
Mailing Address - Street 1:180 CHAMPIONSHIP CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8017
Mailing Address - Country:US
Mailing Address - Phone:678-845-9313
Mailing Address - Fax:
Practice Address - Street 1:180 CHAMPIONSHIP CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8017
Practice Address - Country:US
Practice Address - Phone:678-845-9313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11-00034735253Z00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility