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General NPI Number Information
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NPI Number | 1538970827
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Entity Type | Organization
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Legal Business Name | PHOENIX HOME CARE LLC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 12334 QUARTERBACK CT
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City | BOWIE
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State | MD
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Zip | 20720-4396
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Country | US
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Telephone | 609-705-2561
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Fax |
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Provider Business Mailing Address
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Address Line | 12334 QUARTERBACK CT
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City | BOWIE
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State | MD
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Zip | 20720-4396
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Country | US
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Telephone | 609-705-2561
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KISH BOLDEN
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Credential |
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Telephone | 609-705-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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