# PHOENIX PROVIDER SERVICES

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

## Provider details

- **NPI number:** 1659818185
- **Authorized official:** JAMIE BURGESS (ADMINISTRATOR/OWNER)
- **Authorized official phone:** (254) 220-3322

## Contact information

- **Practice address:** 113 N STAGECOACH RD, SALADO, TX 76571-6109
- **Practice address phone:** (254) 220-3322
- **Mailing address:** 6213 SUELLEN LN, KILLEEN, TX 76542-5479
- **Mailing address phone:** (254) 220-3322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 017609 | TX | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 01/23/2017
- **Last updated:** 01/28/2019