NPI 1124825666
Phoenix Independent Living INC
Practice location
- Address
- 2810 53rd Ave # B, Gulfport, MS 39501-5644
- Phone
- (601) 325-8121
Authorised official
- Name
- Justin Holcomb
- Title
- President
- Phone
- (601) 325-8121
Registered specialties (3)
Adult Care Home Facility
Primary
Medical Laboratory Technician
Non-emergency Medical Transport (VAN)
Registry record
- NPI
- 1124825666
- Entity type
- Organization
- NPI issued
- 3 Mar 2025
- Record last updated
- 3 Mar 2025
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.