Provider Demographics
NPI:1265007975
Name:PHOENIX CARE LLC
Entity Type:Organization
Organization Name:PHOENIX CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ODETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-366-8331
Mailing Address - Street 1:542 LOST GOLD RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-7036
Mailing Address - Country:US
Mailing Address - Phone:254-366-8331
Mailing Address - Fax:
Practice Address - Street 1:542 LOST GOLD RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-7036
Practice Address - Country:US
Practice Address - Phone:254-366-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care