Provider Demographics
NPI:1326145699
Name:PHENIX HOME CARE
Entity Type:Organization
Organization Name:PHENIX HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSARELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:401-943-6230
Mailing Address - Street 1:227 PHENIX AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4013
Mailing Address - Country:US
Mailing Address - Phone:401-943-6230
Mailing Address - Fax:401-943-6265
Practice Address - Street 1:227 PHENIX AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4013
Practice Address - Country:US
Practice Address - Phone:401-943-6230
Practice Address - Fax:401-943-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHCP02418251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPH16189Medicaid
RIPH02548Medicaid