Organization
PHOENIX INDEPENDENT LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN HOLCOMB HOLCOMB (ADMIN)
(601) 325-8121
Entity
Organization
Contact information
Practice address
2810 53RD AVE APT B, GULFPORT, MS 39501-5644
(601) 596-3786
Mailing address
2810 53RD AVE APT B, GULFPORT, MS 39501-5644
(601) 596-3786
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
01/19/2026
Last updated
01/19/2026
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