Provider Demographics
NPI:1326186800
Name:PHOENIX HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:PHOENIX HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:405-249-9709
Mailing Address - Street 1:2526 N MIDWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OK
Mailing Address - Zip Code:73084-3838
Mailing Address - Country:US
Mailing Address - Phone:405-249-9709
Mailing Address - Fax:
Practice Address - Street 1:2526 N MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-3838
Practice Address - Country:US
Practice Address - Phone:405-249-9709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health