Provider Demographics
NPI:1689903890
Name:PHOENIX HOME CARE, INC.
Entity Type:Organization
Organization Name:PHOENIX HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-286-7916
Mailing Address - Street 1:1543 LAKELAND HILLS BLVD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3246
Mailing Address - Country:US
Mailing Address - Phone:863-686-2005
Mailing Address - Fax:863-686-2011
Practice Address - Street 1:1543 LAKELAND HILLS BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3246
Practice Address - Country:US
Practice Address - Phone:863-686-2005
Practice Address - Fax:863-686-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health