Provider Demographics
NPI:1689913394
Name:PHOENIX HOME CARE, INC.
Entity Type:Organization
Organization Name:PHOENIX HOME CARE, INC.
Other - Org Name:PHOENIX HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:KELTNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:417-881-7442
Mailing Address - Street 1:1410 I 70 DR SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2068
Mailing Address - Country:US
Mailing Address - Phone:573-442-9911
Mailing Address - Fax:573-442-9901
Practice Address - Street 1:1410 I 70 DR SW
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2068
Practice Address - Country:US
Practice Address - Phone:573-442-9911
Practice Address - Fax:573-442-9901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX HOME CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health