Organization
PHOENIX HOME CARE ILLINOIS, LLC
Active
Parent organization
PHOENIX HOME CARE, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHOENIX HOME CARE, INC
Authorized official
GEORGE SCOTT HERMAN (PRESIDENT/SECRETARY)
(512) 632-7156
Entity
Organization
Contact information
Practice address
784 WALL ST, SUITE B, O FALLON, IL 62269-1959
(314) 205-3020
(314) 205-3031
Mailing address
3450 N. ROCK RD, #213 ATTN DEBRA MULLEN, WICHITA, KS 67226
(316) 688-5511
(314) 205-3031
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266501303
—
MO
Enumeration date
04/28/2015
Last updated
12/03/2021
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