NPIMap

Organization Active NPI

Phoenix Independent Living Inc

  • In Home Supportive Care Agency
  • Gulfport, MS
National Provider Identifier
1043179864
Registry record updated Jan 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
PHOENIX INDEPENDENT LIVING INC
Practice address
2810 53Rd Ave Apt B
Gulfport, MS 39501-5644
Phone
(601) 596-3786
NPI assigned
Jan 17, 2026
Last updated
Jan 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2026

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

Authorized official

Name
Justin Holcomb, HOLCOMB
Title
Administration
Phone
(601) 325-8121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Care Attendant 3747P1801X NU
In Home Supportive Care Agency 253Z00000X NU Primary

Addresses

Primary practice location

2810 53Rd Ave Apt B
Gulfport, MS 39501-5644

Mailing address

2810 53Rd Ave Apt B
Gulfport, MS 39501-5644
Phone (601) 596-3786

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Independent Living Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1768608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768608000000",
    "number": "1043179864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 53RD AVE APT B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395015644",
            "telephone_number": "601-596-3786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 53RD AVE APT B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395015644",
            "telephone_number": "601-596-3786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX INDEPENDENT LIVING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-17",
        "last_updated": "2026-01-17",
        "certification_date": "2026-01-17",
        "status": "A",
        "authorized_official_last_name": "HOLCOMB",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "601-325-8121",
        "authorized_official_credential": "HOLCOMB"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.