# PHOENIX SQUARED, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Comfort Keepers of Marietta
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609493725
- **Authorized official:** DALE ENIX (OWNER)
- **Authorized official phone:** (678) 354-0102

## Contact information

- **Practice address:** 240 CHEROKEE ST NE STE 302, MARIETTA, GA 30060-1628
- **Practice address phone:** (678) 354-0102
- **Practice address fax:** (678) 354-0014
- **Mailing address:** 240 CHEROKEE ST NE STE 302, MARIETTA, GA 30060-1628
- **Mailing address phone:** (678) 354-0102
- **Mailing address fax:** (678) 354-0014

## Taxonomy

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

## Other

- **Enumeration date:** 07/06/2020
- **Last updated:** 07/07/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 033-R-0092 | DEPARTMENT OF COMMUNITY HEALTH PRIVATE HOME CARE PROVIDER PERMIT | GA |