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General NPI Number Information
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NPI Number | 1871314211
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Entity Type | Organization
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Legal Business Name | PHOENIX SKILLED NURSING AGENCY LLC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 530 HIGHLAND STATION DR STE 3002
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City | SUWANEE
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State | GA
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Zip | 30024-6576
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Country | US
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Telephone | 470-266-1509
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Fax | 470-266-1540
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Provider Business Mailing Address
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Address Line | 530 HIGHLAND STATION DR STE 3002
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City | SUWANEE
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State | GA
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Zip | 30024-6576
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMEM UDO
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Credential |
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Telephone | 404-390-5587
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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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