MEDICARE: PHOENIX COMMUNITY LIVING & CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1922961994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX COMMUNITY LIVING & CARE LLC

Provider Business Mailing Address
First Line	:	236 CHIANTI CT
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-6538
Country	:	US
Telephone Number	:	314-265-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 CHIANTI CT
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-6538
Country	:	US
Telephone Number	:	314-265-8322
Fax Number	:

Authorized Official
Title or Position	:	CO-FOUNDER & CCO
Name	:	SHARON MCCARTHY
Credential	:	RN
Telephone Number	:	314-265-8322

Provider Enumeration Date	:	12/06/2025
Last Update Date	:	12/06/2025

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