Healthcare Provider Details

I. General information

NPI: 1568728830
Provider Name (Legal Business Name): PHYLCHRIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 11/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4-4-14 ESTATE FORTUNA
ST. THOMAS VI
00802
US

IV. Provider business mailing address

PO BOX 8980
ST THOMAS VI
00801-1980
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-9715
  • Fax:
Mailing address:
  • Phone: 340-774-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1-8208-3L
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1-8208-3L
License Number StateVI
# 3
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1-8208-2L
License Number StateVI
# 4
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1-8208-3L
License Number StateVI

VIII. Authorized Official

Name: MRS. PHYLLIS MASSAC
Title or Position: PRESIDENT
Credential: RN, BSN, MSN
Phone: 340-774-9177