Phoenix Home Care Illinois, LLC

NPI #1720465834 in O Fallon, Illinois

Provider Information

NPI Number: 1720465834
Entity Type: Organization
Organization Name: Phoenix Home Care Illinois, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: PHOENIX HOME CARE, INC
Primary Specialty: Nursing Care
Enumeration Date: Apr 28, 2015
Last Updated: Dec 3, 2021

Practice Location

Address: 784 WALL ST
Address 2: SUITE B
City: O Fallon
State: Illinois
ZIP Code: 62269-1959
Phone: (314) 205-3020

Authorized Official

Name: GEORGE SCOTT HERMAN
Title: PRESIDENT/SECRETARY
Phone: (512) 632-7156

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nursing Care	251J00000X	Primary

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