Provider Demographics
NPI:1457751265
Name:PHOENIX HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:PHOENIX HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOENIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-735-0976
Mailing Address - Street 1:4793 SHALLOWFORD CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7924
Mailing Address - Country:US
Mailing Address - Phone:757-735-0976
Mailing Address - Fax:
Practice Address - Street 1:4793 SHALLOWFORD CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7924
Practice Address - Country:US
Practice Address - Phone:757-735-0976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA147587-0000-7200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health