Organization
PHOENIX PROVIDER SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE BURGESS (ADMINISTRATOR/OWNER)
(254) 220-3322
Entity
Organization
Contact information
Practice address
113 N STAGECOACH RD, SALADO, TX 76571-6109
(254) 220-3322
Mailing address
6213 SUELLEN LN, KILLEEN, TX 76542-5479
(254) 220-3322
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
017609
TX
253Z00000X
In Home Supportive Care Agency
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Other
Enumeration date
01/23/2017
Last updated
01/28/2019
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