Provider Demographics
NPI:1366820318
Name:PHOENIX HOME CARE, LLC
Entity Type:Organization
Organization Name:PHOENIX HOME CARE, LLC
Other - Org Name:PHOENIX HOME CARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-688-5511
Mailing Address - Street 1:3450 N. ROCK RD.
Mailing Address - Street 2:#213, ATTN: DEBRA MULLEN
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 1:14220 E 42ND ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4726
Practice Address - Country:US
Practice Address - Phone:816-373-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based