Provider Demographics
NPI:1407348022
Name:PHOENIX HOME CARE PASSPORT PROGRAM INC
Entity Type:Organization
Organization Name:PHOENIX HOME CARE PASSPORT PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJENDER
Authorized Official - Middle Name:ALUGUBELLI
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-888-8885
Mailing Address - Street 1:30 NORTHWOODS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4736
Mailing Address - Country:US
Mailing Address - Phone:614-888-8885
Mailing Address - Fax:614-888-8893
Practice Address - Street 1:30 NORTHWOODS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4736
Practice Address - Country:US
Practice Address - Phone:614-888-8885
Practice Address - Fax:614-888-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health