Provider Demographics
NPI:1891251351
Name:PHOENIX HOME CARE OF VIRGINIA
Entity Type:Organization
Organization Name:PHOENIX HOME CARE OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-695-4330
Mailing Address - Street 1:300 FRANKLIN ST STE 238
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2162
Mailing Address - Country:US
Mailing Address - Phone:336-695-4331
Mailing Address - Fax:336-621-3342
Practice Address - Street 1:300 FRANKLIN ST
Practice Address - Street 2:SUITE 238
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2411
Practice Address - Country:US
Practice Address - Phone:336-695-4331
Practice Address - Fax:336-621-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health