Provider Demographics
NPI:1861240632
Name:PHOENIX FAMILIES UNITED, LLC
Entity type:Organization
Organization Name:PHOENIX FAMILIES UNITED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PCA / INSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRIDALE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-690-1001
Mailing Address - Street 1:502 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7555
Mailing Address - Country:US
Mailing Address - Phone:907-690-1001
Mailing Address - Fax:
Practice Address - Street 1:601 FRONTAGE RD STE 206
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7783
Practice Address - Country:US
Practice Address - Phone:907-690-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health