Healthcare Provider Details

I. General information

NPI: 1447016951
Provider Name (Legal Business Name): PHOCCUS HEALTH COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 N 1ST ST
RICHMOND VA
23219-1000
US

IV. Provider business mailing address

3353 MEADOWMONT LN
RICHMOND VA
23223-2148
US

V. Phone/Fax

Practice location:
  • Phone: 804-601-6263
  • Fax:
Mailing address:
  • Phone: 804-898-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: DESIRE'E LEWIS-NELSON
Title or Position: CEO
Credential:
Phone: 804-898-6092