Phoenix Squared, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

PHOENIX SQUARED, LLC

Practice address

240 Cherokee St NE Ste 302
Marietta, GA 30060-1628

Phone

(678) 354-0102

Fax

(678) 354-0014

NPI assigned

Jul 6, 2020

Organization subpart

No

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

Authorized official

Name

Dale Enix

Title

Owner

Phone

(678) 354-0102

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Comfort Keepers of Marietta Doing business as

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

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594080000000",
    "number": "1609493725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 CHEROKEE ST NE STE 302",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601628",
            "telephone_number": "678-354-0102",
            "fax_number": "678-354-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 CHEROKEE ST NE STE 302",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601628",
            "telephone_number": "678-354-0102",
            "fax_number": "678-354-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SQUARED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-06",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A",
        "authorized_official_last_name": "ENIX",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-354-0102"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF COMMUNITY HEALTH PRIVATE HOME CARE PROVIDER PERMIT",
            "identifier": "033-R-0092",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfort Keepers of Marietta",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Comfort Keepers of Marietta",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kassie Phillips, A.S. & RBT
• Sara Evans Phillips, O.T.R.L
• Sascha Phillips
• Taylor Marie Phillips
• Wendy Sue Phillips, D.C.
• William Eloridge Phoenix, DC
• Phyllis a Garrett
• Physical Medicine Center
• Physical Therapy Consultants Inc
• Physical Therapy Partners of Georgia, LLC

• In Home Supportive Care Agency in Marietta, GA
• Providers in Marietta, GA by specialty
• In Home Supportive Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.