Provider Demographics
NPI:1477544823
Name:PHOENIX HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:PHOENIX HOME HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-748-5908
Mailing Address - Street 1:34 35TH ST STE 4-5B516
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2021
Mailing Address - Country:US
Mailing Address - Phone:248-824-6000
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:500 KIRTS BLVD
Practice Address - Street 2:STE 270
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4135
Practice Address - Country:US
Practice Address - Phone:248-591-0265
Practice Address - Fax:248-591-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-7510Medicare PIN
MI23-7510,PTANMedicare UPIN
MI4608510Medicaid
237510Medicare Oscar/Certification