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General NPI Number Information
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NPI Number | 1669313003
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Entity Type | Organization
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Legal Business Name | PHOENIX NEST HOME, INC
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 10203 COUNT FLEET DR
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City | RUSKIN
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State | FL
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Zip | 33573-6774
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Country | US
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Telephone | 813-843-4645
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Fax | 813-448-1237
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Provider Business Mailing Address
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Address Line | 10203 COUNT FLEET DR
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City | RUSKIN
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State | FL
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Zip | 33573-6774
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Country | US
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Telephone | 813-843-4645
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Fax | 813-448-1237
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DIANA ANIOCE-ANDRE
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Credential | LMHC
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Telephone | 813-843-4645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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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 | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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