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Organization
PHENOMENAL PHOENIX ENTERPRISES, LLC
Active
Organization
PHENOMENAL PHOENIX ENTERPRISES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE JACKSON (OWNER)
(313) 957-8664
Entity
Organization
Contact information
Practice address
24125 WEDGEWOOD CIR, WARREN, MI 48091-5874
(313) 957-8664
Mailing address
7631 WARWICK ST UPPR, DETROIT, MI 48228-3318
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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