=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326145699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHENIX HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 PHENIX AVE
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02920-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-943-6230
-----------------------------------------------------
Fax | 401-943-6265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 227 PHENIX AVE
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02920-4013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-943-6230
-----------------------------------------------------
Fax | 401-943-6265
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. NICHOLAS PASSARELLI JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-943-6230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCP02418
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------