# PHOENIX INDEPENDENT LIVING INC

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

## Provider details

- **NPI number:** 1124825666
- **Authorized official:** JUSTIN HOLCOMB (PRESIDENT)
- **Authorized official phone:** (601) 325-8121

## Contact information

- **Practice address:** 2810 53RD AVE \# B, GULFPORT, MS 39501-5644
- **Practice address phone:** (601) 325-8121
- **Mailing address:** 2810 53RD AVE \# B, GULFPORT, MS 39501-5644
- **Mailing address phone:** (601) 325-8121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246RM2200X | Medical Laboratory Technician | — | NULL | — |
| 246RM2200X | Medical Laboratory Technician | — | — | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 03/03/2025
- **Last updated:** 03/03/2025