Healthcare Provider Details

I. General information

NPI: 1447830922
Provider Name (Legal Business Name): PHOENIX PRO MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S ROSEMARY AVE STE 204-2052
WEST PALM BEACH FL
33401-6313
US

IV. Provider business mailing address

700 S ROSEMARY AVE STE 204-2052
WEST PALM BEACH FL
33401-6313
US

V. Phone/Fax

Practice location:
  • Phone: 561-236-9384
  • Fax: 361-210-1136
Mailing address:
  • Phone: 561-236-9384
  • Fax: 361-210-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: ALEX MODRIC
Title or Position: OWNER
Credential: CONTRACTOR
Phone: 561-591-7597