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General NPI Number Information
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NPI Number | 1780754390
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Entity Type | Organization
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Legal Business Name | PHOENIX HOME CARE SERVICE, INC.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 2302 34TH ST
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City | LUBBOCK
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State | TX
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Zip | 79411-1634
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Country | US
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Telephone | 806-784-0033
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Fax | 806-784-0603
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Provider Business Mailing Address
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Address Line | 2302 34TH ST
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City | LUBBOCK
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State | TX
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Zip | 79411-1634
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Country | US
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Telephone | 806-784-0033
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Fax | 806-784-0603
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ANNETTE SCARBOROUGH
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Credential | RN, BSN
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Telephone | 806-784-0033
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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 | 013599
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License Number State | TX
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