MEDICARE: PHOENIX HOME CARE 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	:	1619751138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX HOME CARE INC

Provider Business Mailing Address
First Line	:	2785 GARFIELD RD N STE C
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-5168
Country	:	US
Telephone Number	:	231-268-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	2785 GARFIELD RD N STE C
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-5168
Country	:	US
Telephone Number	:	231-268-0027
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	SARAH EE BENSON
Credential	:
Telephone Number	:	231-268-0027

Provider Enumeration Date	:	08/24/2023
Last Update Date	:	08/24/2023

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