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Phoenix Supported Living Inc

Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Andrews, NC

NPI 1487700258 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1487700258
Entity type
Organization (NPI type 2)
Primary specialty
Mental Illness Community Based Residential Treatment Facility 320800000X
License
7805529 (NC)
Legal business name
PHOENIX SUPPORTED LIVING INC
Practice address
19645 US 19
Andrews, NC 28901
Phone
(828) 389-1795
Fax
(828) 389-1658
NPI assigned
Jan 26, 2007
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 13

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

National Provider Directory

Tax ID family
Phoenix Supported Living Inc (14 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 7805529 NC Yes

Addresses

Primary practice location

19645 US 19
Andrews, NC 28901

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
7805529MedicaidNC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487700258",
    "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": "19645 US 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": "2007-01-26",
        "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."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "7805529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805529",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Andrews, NC

All providers in Andrews, NC · Mental Illness Community Based Residential Treatment Facility in North Carolina

Sources for this page

Verify at the official NPI Registry.