Provider Demographics
NPI:1700699972
Name:PHOENIX CARE LLC
Entity type:Organization
Organization Name:PHOENIX CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDULLAHI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-407-8681
Mailing Address - Street 1:888 COUNTY ROAD D W STE 108
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-8519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:888 COUNTY ROAD D W STE 108
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-8519
Practice Address - Country:US
Practice Address - Phone:612-407-8681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health