MEDICARE: PHOENIX PRO MANAGEMENT, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171WH0202X	Home Modifications Contractor
2	171WV0202X	Vehicle Modifications Contractor
3	253Z00000X	In Home Supportive Care Agency
4	332BC3200X	Customized Equipment (DME)
5	372500000X	Chore Provider
6	171W00000X	Contractor

General Provider Information

NPI Number	:	1447830922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX PRO MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	700 S ROSEMARY AVE STE 204-2052
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6313
Country	:	US
Telephone Number	:	561-236-9384
Fax Number	:	361-210-1136

Provider Business Practice Location Address
First Line	:	700 S ROSEMARY AVE STE 204-2052
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6313
Country	:	US
Telephone Number	:	561-236-9384
Fax Number	:	361-210-1136

Authorized Official
Title or Position	:	OWNER
Name	:	ALEX MODRIC
Credential	:	CONTRACTOR
Telephone Number	:	561-591-7597

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	01/17/2025

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Directions to “PHOENIX PRO MANAGEMENT, INC ” Practice Location

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