MEDICARE: PHOENIX HEALTH CARE 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	311500000X	Alzheimer Center (Dementia Center)	NH5534-5534	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972518835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	225 SW 35TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-6807
Country	:	US
Telephone Number	:	405-631-7444
Fax Number	:	405-631-1230

Provider Business Practice Location Address
First Line	:	225 SW 35TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-6807
Country	:	US
Telephone Number	:	405-631-7444
Fax Number	:	405-631-1230

Authorized Official
Title or Position	:	REGIONAL BUSINESS OFFICE MANAGER
Name	:	BRANDI HOLLAND
Credential	:
Telephone Number	:	918-743-3638

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	04/18/2023

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Directions to “PHOENIX HEALTH CARE LLC ” Practice Location

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