Provider Demographics
NPI:1730931882
Name:NEW PHOENIX LLC.
Entity type:Organization
Organization Name:NEW PHOENIX LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-294-8408
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:BLACK CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27813-0335
Mailing Address - Country:US
Mailing Address - Phone:252-294-8408
Mailing Address - Fax:
Practice Address - Street 1:127 GOLDSBORO ST S STE 212
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4903
Practice Address - Country:US
Practice Address - Phone:252-294-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care