Organization
PHOENIX SUPPORTED LIVING INC
Active
Organization
PHOENIX SUPPORTED LIVING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANET MELISSA NEMKOVICH (DIRECTOR)
(828) 389-1795
Entity
Organization
Contact information
Practice address
2996 NC 69, SUITE 6, HAYESVILLE, NC 28904-7257
(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
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
3409428
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409428
—
NC
Enumeration date
01/26/2007
Last updated
05/11/2012
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