OrganizationActive
Phoenix Independent Living Inc
NPI 1124825666 · Adult Care Home Facility · Gulfport, MS
Provider details
- NPI number
- 1124825666
- Entity type
- Organization
- Primary specialty
- Adult Care Home FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Justin Holcomb, President(601) 325-8121
Specialties & taxonomies
Nursing & Custodial Care Facilities
- Medical Laboratory Technician246RM2200X
Technologists, Technicians & Other Technical Service Providers
- Non-emergency Medical Transport (VAN)343900000X
Transportation Services
Practice location
2810 53rd Ave # B
Gulfport, MS 39501-5644
Phone: (601) 325-8121
Approximate (ZIP-level) locationGet directions
Mailing address
2810 53rd Ave # B
Gulfport, MS 39501-5644
Registry dates
- Enumerated
- 2025-03-03
- Last updated
- 2025-03-03
- Certified
- 2025-03-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.