Provider Demographics
NPI:1356084396
Name:PHOENIX HOME CARE, LLC
Entity Type:Organization
Organization Name:PHOENIX HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:MELUGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-688-5511
Mailing Address - Street 1:3450 N ROCK RD STE 213
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1352
Mailing Address - Country:US
Mailing Address - Phone:316-688-5511
Mailing Address - Fax:
Practice Address - Street 1:2088 CRAIGSHIRE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4010
Practice Address - Country:US
Practice Address - Phone:365-730-0376
Practice Address - Fax:866-352-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based