Organization
PHOENIX SUPPORTED LIVING INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANET MELISSA NEMKOVICH IX (DIRECTOR)
(828) 389-1795
Entity
Organization
Contact information
Practice address
19 645 HWY 19, ANDREWS, NC 28901
(828) 389-1795
(828) 389-1658
Mailing address
2996 NC 69, SUITE 6, HAYESVILLE, NC 28904-7257
(828) 389-1795
(828) 389-1658
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
8300926
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300926
—
NC
Enumeration date
01/29/2007
Last updated
08/22/2020
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