MEDICARE: FENYX COMMUNITY CONSULTATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1093542565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FENYX COMMUNITY CONSULTATION INC

Provider Business Mailing Address
First Line	:	1356 7TH ST E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-4104
Country	:	US
Telephone Number	:	651-410-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	1356 7TH ST E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-4104
Country	:	US
Telephone Number	:	651-410-2999
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PANG KOU LOR
Credential	:	DNP
Telephone Number	:	651-410-8299

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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