Phenomenal Healthcare, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

PHENOMENAL HEALTHCARE, LLC

Doing business as

Home Care for the 21st Century- Jacksonville

Practice address

6815 Atlantic Blvd Ste 3
Jacksonville, FL 32211-8764

Phone

(904) 438-5837

NPI assigned

Mar 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marlena EllisNPI 1477008837

Title

President/Treasurer

Phone

(904) 438-5837

Specialties & licenses 2

Addresses

Other names 1

• Home Care for the 21st Century- Jacksonville Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Home health agency certification: CCN 687208

Legal name

PHENOMENAL HEALTHCARE LLC

Doing business as

HOME CARE FOR THE 21ST CENTURY -JACKSONVILLE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 22, 2022

Last certification

Aug 11, 2022

Organization structure

LLCProprietary

Incorporated

in FL

Enrollment address

6815 Atlantic Blvd
Ste 3
Jacksonville, FL 32211-8764

Listed as

Phenomenal Healthcare, LLCCCN 687208 · All quality measures

Ownership

-

Certified

Aug 22, 2022

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Marlena Shandrell Ellis, FNP

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1477008837

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marlena Shandrell Ellis, FNP

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1477008837
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1023603503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6815 ATLANTIC BLVD STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322118764",
            "telephone_number": "904-438-5837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6815 ATLANTIC BLVD STE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322118764",
            "telephone_number": "904-438-5837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHENOMENAL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-05",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "MARLENA",
        "authorized_official_title_or_position": "PRESIDENT/TREASURER",
        "authorized_official_telephone_number": "904-438-5837"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Home Care for the 21st Century- Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Home Care for the 21st Century- Jacksonville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jordan Micah Phelps, DO
• Julie Phelps
• Kenneth Richard Phelps, PA-C
• Laran Phelps, LMT
• Shericka Rose Phelps
• Dalia Philbeck, ARNP, CNM
• Lauren Beth Philbrick
• Jeenu Philip, RPH
• Sunila Sarah Philipose, PHARM.D
• Cathiana Philippe, LCSW

• In Home Supportive Care Agency in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• In Home Supportive Care Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.