Provider Demographics
NPI:1144044652
Name:PHOENIX PALLIATIVE CARE
Entity type:Organization
Organization Name:PHOENIX PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:718-902-4251
Mailing Address - Street 1:258 N WEST END BLVD # 146
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2324
Mailing Address - Country:US
Mailing Address - Phone:718-902-4251
Mailing Address - Fax:
Practice Address - Street 1:1105 RED BARN LN
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-2427
Practice Address - Country:US
Practice Address - Phone:718-902-4251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty