# PHENOMENAL PHOENIX ENTERPRISES, LLC

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

## Provider details

- **NPI number:** 1376226514
- **Authorized official:** DOMINIQUE JACKSON (OWNER)
- **Authorized official phone:** (313) 957-8664

## Contact information

- **Practice address:** 24125 WEDGEWOOD CIR, WARREN, MI 48091-5874
- **Practice address phone:** (313) 957-8664
- **Mailing address:** 7631 WARWICK ST UPPR, DETROIT, MI 48228-3318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 08/14/2023
- **Last updated:** 08/14/2023