Organization
PHOENIX INDEPENDENT LIVING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN HOLCOMB (PRESIDENT)
(601) 325-8121
Entity
Organization
Contact information
Practice address
2810 53RD AVE # B, GULFPORT, MS 39501-5644
(601) 325-8121
Mailing address
2810 53RD AVE # B, GULFPORT, MS 39501-5644
(601) 325-8121
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
03/03/2025
Last updated
03/03/2025
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