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General NPI Number Information
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NPI Number | 1689903890
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Entity Type | Organization
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Legal Business Name | PHOENIX HOME CARE, INC.
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 1543 LAKELAND HILLS BLVD SUITE 16
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City | LAKELAND
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State | FL
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Zip | 33805-3246
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Country | US
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Telephone | 863-686-2005
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Fax | 863-686-2011
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Provider Business Mailing Address
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Address Line | 1543 LAKELAND HILLS BLVD SUITE 16
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City | LAKELAND
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State | FL
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Zip | 33805-3246
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Country | US
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Telephone | 863-686-2005
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Fax | 863-686-2011
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | MR. ROBERT P GAMMONS
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Credential |
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Telephone | 321-286-7916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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