Provider Demographics
NPI:1205074077
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 1:50 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4416
Mailing Address - Country:US
Mailing Address - Phone:407-846-2252
Mailing Address - Fax:407-846-2256
Practice Address - Street 1:50 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4416
Practice Address - Country:US
Practice Address - Phone:407-846-2252
Practice Address - Fax:407-846-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-31
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health