NPI 1134226509

Phoenix Residence, INC.

Organisation Intellectual Disabilities Intermediate Care Facility Maplewood, MN

Practice location

Address: 2465 Carver Ave, Maplewood, MN 55119
Phone: (651) 702-8995
Fax: (651) 702-2511
Mailing address: 330 Marie Ave E, West St Paul, MN 55118-4011

Authorised official

Name: Darlene M Scott
Title: President/Ceo
Phone: (651) 227-7655

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 1033706 1 RS (MN)

Other Intermediate Care Facility, Intellectual Disabilities providers in Minnesota →

Registry record

NPI: 1134226509
Entity type: Organization
NPI issued: 20 Sep 2006
Record last updated: 1 Jul 2008

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.