Provider Demographics
NPI:1932271335
Name:PHOENIX HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:PHOENIX HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-389-4699
Mailing Address - Street 1:2996 NC 69 S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904
Mailing Address - Country:US
Mailing Address - Phone:828-389-4699
Mailing Address - Fax:828-389-1658
Practice Address - Street 1:2996 NC 69 S
Practice Address - Street 2:SUITE 5
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904
Practice Address - Country:US
Practice Address - Phone:828-389-4699
Practice Address - Fax:828-389-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2890251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601306Medicaid
NC3408482OtherCAP MEDICAID