Phoenix Supported Living Inc
Organization Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Andrews, NC
NPI 1013053255 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1013053255
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
- License
- 8300925 (NC)
- Legal business name
- PHOENIX SUPPORTED LIVING INC
- Practice address
- 48 Britian Trace
Andrews, NC 28901 - Phone
- (828) 389-1795
- Fax
- (828) 389-1658
- NPI assigned
- Jan 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Janet Melissa Nemkovich
- Title
- Director
- Phone
- (828) 389-1795
Corporate family (same tax ID) 13
National Provider Directory
- Tax ID family
- Phoenix Supported Living Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | 8300925 | NC | Yes |
Addresses
Primary practice location
48 Britian Trace
Andrews, NC 28901
Mailing address
2996 NC 69
Suite 6
Hayesville, NC 28904-7257
Phone (828) 389-1795
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8300925 | Medicaid | NC |
Other providers in Andrews, NC
- Kelly Patterson
- Paytons Place
- Meagan E Pedersen
- Personal Touch Assisted Living
- Personal Touch Assisted Living
- Phoenix Supported Living Inc
- Phoenix Supported Living Inc
- Phoenix Supported Living Inc
- Phoenix Supported Living Inc
- Phoenix Supported Living Inc.
All providers in Andrews, NC · Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.