Provider Demographics
NPI:1467031765
Name:PHOENIX HOME CARE INC
Entity Type:Organization
Organization Name:PHOENIX HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
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 1:1839 E INDEPENDENCE ST STE K
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3753
Mailing Address - Country:US
Mailing Address - Phone:417-881-7442
Mailing Address - Fax:417-988-9844
Practice Address - Street 1:1839 E INDEPENDENCE ST STE K
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3753
Practice Address - Country:US
Practice Address - Phone:417-881-7442
Practice Address - Fax:417-988-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty