MEDICARE: PHOEBE CARE RESIDENTIAL SERVICES, LLC

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1477307742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOEBE CARE RESIDENTIAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	2718 SAND HILLS DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-5256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2718 SAND HILLS DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-5256
Country	:	US
Telephone Number	:	804-414-4212
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/RISK MANAGER
Name	:	MRS. SHIBON SWAINE SPENCE
Credential	:
Telephone Number	:	804-414-4212

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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