NPIMap

Organization Active NPI

Phoenix Independent Living Inc

  • Adult Care Home Facility
  • Gulfport, MS
National Provider Identifier
1124825666
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
PHOENIX INDEPENDENT LIVING INC
Practice address
2810 53Rd Ave # B
Gulfport, MS 39501-5644
Phone
(601) 325-8121
NPI assigned
Mar 3, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Authorized official

Name
Justin Holcomb
Title
President
Phone
(601) 325-8121

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Laboratory TechnicianGroup: 193400000X SINGLE SPECIALTY GROUP 246RM2200X
Adult Care Home Facility 311ZA0620X Primary
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

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

Mailing address

2810 53Rd Ave # B
Gulfport, MS 39501-5644
Phone (601) 325-8121

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": "1740960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740960000000",
    "number": "1124825666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 53RD AVE # B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395015644",
            "telephone_number": "601-325-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 53RD AVE # B",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395015644",
            "telephone_number": "601-325-8121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX INDEPENDENT LIVING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-01",
        "status": "A",
        "authorized_official_last_name": "HOLCOMB",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-325-8121"
    },
    "taxonomies": [
        {
            "code": "246RM2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Pathology, Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Mar 3, 2025; 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.