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Organization
PHOENIX SQUARED, LLC
Active
Organization
PHOENIX SQUARED, LLC
Active
Other names
Comfort Keepers of Marietta
Organization subpart
No
Provider details
NPI number
Authorized official
DALE ENIX (OWNER)
(678) 354-0102
Entity
Organization
Contact information
Practice address
240 CHEROKEE ST NE STE 302, MARIETTA, GA 30060-1628
(678) 354-0102
(678) 354-0014
Mailing address
240 CHEROKEE ST NE STE 302, MARIETTA, GA 30060-1628
(678) 354-0102
(678) 354-0014
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033-R-0092
DEPARTMENT OF COMMUNITY HEALTH PRIVATE HOME CARE PROVIDER PERMIT
GA
Enumeration date
07/06/2020
Last updated
07/07/2020
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