Provider Demographics
NPI:1649589045
Name:PHENOMENAL LIVING INC
Entity Type:Organization
Organization Name:PHENOMENAL LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIVIETTE
Authorized Official - Middle Name:NORSHENIA
Authorized Official - Last Name:PHARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-846-8273
Mailing Address - Street 1:21910 CATOOSA DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-6902
Mailing Address - Country:US
Mailing Address - Phone:281-846-8273
Mailing Address - Fax:832-813-8569
Practice Address - Street 1:21910 CATOOSA DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-6902
Practice Address - Country:US
Practice Address - Phone:281-846-8273
Practice Address - Fax:832-813-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-02
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services