=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952087629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PHOENIX SENIORS CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2023
-----------------------------------------------------
Last Update Date | 07/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16877 E COLONIAL DR # 187
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32820-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-373-1491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16877 E COLONIAL DR # 187
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32820-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-373-1491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GEORGIA BECKFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-435-8362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------