NPIMap

Organization Active NPI

Phoenix Supported Living Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Andrews, NC
National Provider Identifier
1083750228
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
8300926 Issued in NC
Legal business name
PHOENIX SUPPORTED LIVING INC.
Practice address
19 645 Hwy 19
Andrews, NC 28901
Phone
(828) 389-1795
Fax
(828) 389-1658
NPI assigned
Jan 29, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Janet Melissa Nemkovich IX
Title
Director
Phone
(828) 389-1795

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 8300926 NC Primary

Addresses

Primary practice location

19 645 Hwy 19
Andrews, NC 28901

Mailing address

2996 NC 69
Suite 6
Hayesville, NC 28904-7257
Phone (828) 389-1795

Other identifiers 1

IdentifierTypeStateIssuer
8300926MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Supported Living Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083750228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2996 NC 69",
            "address_2": "SUITE 6",
            "city": "HAYESVILLE",
            "state": "NC",
            "postal_code": "289047257",
            "telephone_number": "828-389-1795",
            "fax_number": "828-389-1658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 645 HWY 19",
            "city": "ANDREWS",
            "state": "NC",
            "postal_code": "28901",
            "telephone_number": "828-389-1795",
            "fax_number": "828-389-1658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SUPPORTED LIVING INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NEMKOVICH",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "828-389-1795",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_name_suffix": "IX"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "8300926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300926",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Andrews, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.