# PHOENIX COMMUNITY SUPPORT SERVICES LLC

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

## Provider details

- **NPI number:** 1861099186
- **Authorized official:** LASHUNDA SMITH POPE (OWNER)
- **Authorized official phone:** (205) 346-3123

## Contact information

- **Practice address:** 4111 AVENUE L, BIRMINGHAM, AL 35208-1807
- **Practice address phone:** (803) 849-2925
- **Mailing address:** 4111 AVENUE L, BIRMINGHAM, AL 35208-1807
- **Mailing address phone:** (803) 849-2925

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 172A00000X | Driver | — | NULL | Yes |
| 172A00000X | Driver | — | — | Yes |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 10/09/2020
- **Last updated:** 10/27/2020