# PHOENIX SUPPORTED LIVING INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013053255
- **Authorized official:** MRS. JANET MELISSA NEMKOVICH (DIRECTOR)
- **Authorized official phone:** (828) 389-1795

## Contact information

- **Practice address:** 48 BRITIAN TRACE, ANDREWS, NC 28901
- **Practice address phone:** (828) 389-1795
- **Practice address fax:** (828) 389-1658
- **Mailing address:** 2996 NC 69, SUITE 6, HAYESVILLE, NC 28904-7257
- **Mailing address phone:** (828) 389-1795
- **Mailing address fax:** (828) 389-1658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 8300925 | NC | Yes |

## Other

- **Enumeration date:** 01/29/2007
- **Last updated:** 08/22/2020