Provider Demographics
NPI:1952087629
Name:THE PHOENIX SENIORS CARE LLC
Entity Type:Organization
Organization Name:THE PHOENIX SENIORS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-435-8362
Mailing Address - Street 1:16877 E COLONIAL DR # 187
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-1910
Mailing Address - Country:US
Mailing Address - Phone:877-373-1491
Mailing Address - Fax:
Practice Address - Street 1:16877 E COLONIAL DR # 187
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32820-1910
Practice Address - Country:US
Practice Address - Phone:877-373-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty