Provider Demographics
NPI:1093542565
Name:FENYX COMMUNITY CONSULTATION INC
Entity type:Organization
Organization Name:FENYX COMMUNITY CONSULTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PANG
Authorized Official - Middle Name:KOU
Authorized Official - Last Name:LOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:651-410-8299
Mailing Address - Street 1:1356 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-4104
Mailing Address - Country:US
Mailing Address - Phone:651-410-8299
Mailing Address - Fax:
Practice Address - Street 1:1356 7TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-4104
Practice Address - Country:US
Practice Address - Phone:651-410-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health