Provider Demographics
NPI:1649509852
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 OWNER
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 1:14004 ROOSEVELT BLVD
Mailing Address - Street 2:610
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3823
Mailing Address - Country:US
Mailing Address - Phone:727-532-9900
Mailing Address - Fax:727-532-9933
Practice Address - Street 1:14004 ROOSEVELT BLVD
Practice Address - Street 2:610
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3823
Practice Address - Country:US
Practice Address - Phone:727-532-9900
Practice Address - Fax:727-532-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health