NPIMap

Organization Active NPI

Phoenix Supported Living Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Andrews, NC
National Provider Identifier
1366598336
Registry record updated May 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
7804847 Issued in NC
Legal business name
PHOENIX SUPPORTED LIVING INC
Practice address
48 Brittian Trace
Andrews, NC 28901
Phone
(828) 389-1795
Fax
(828) 389-1658
NPI assigned
Jan 25, 2007
Last updated
May 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2012

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 7804847 NC Primary

Addresses

Primary practice location

48 Brittian Trace
Andrews, NC 28901

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
7804847MedicaidNC

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": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336694400000",
    "number": "1366598336",
    "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": "48 BRITTIAN TRACE",
            "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": "2007-01-25",
        "last_updated": "2012-05-11",
        "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."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "7804847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804847",
            "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 May 11, 2012; 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.