Provider Demographics
NPI:1891374179
Name:RIVER PHOENIX HEALTH LLC
Entity Type:Organization
Organization Name:RIVER PHOENIX HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONASMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-234-4050
Mailing Address - Street 1:1800 MORMON MILL RD STE A6
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-4176
Mailing Address - Country:US
Mailing Address - Phone:512-234-4050
Mailing Address - Fax:512-234-4051
Practice Address - Street 1:1800 MORMON MILL RD STE A6
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4176
Practice Address - Country:US
Practice Address - Phone:512-234-4050
Practice Address - Fax:512-234-4051
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?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care