Provider Demographics
NPI:1356808653
Name:NPHALANX LLC
Entity type:Organization
Organization Name:NPHALANX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AM
Authorized Official - Prefix:
Authorized Official - First Name:PHEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-815-8468
Mailing Address - Street 1:134 PICTURE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4533
Mailing Address - Country:US
Mailing Address - Phone:412-932-5372
Mailing Address - Fax:
Practice Address - Street 1:1201 FALLS AVE E STE 25
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3464
Practice Address - Country:US
Practice Address - Phone:412-932-5372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-23
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID4150053OtherIDAAHO CERTIFICATE OF REGISTRATION
PA6834147OtherFICTITIOUS NAME REGISTRATION