NPI 1245324920

Phoenix Residence INC

Organisation Intellectual Disabilities Intermediate Care Facility Maplewood, MN

Practice location

Address: 1866 Furness Street, Maplewood, MN 55109
Phone: (651) 777-6349
Fax: (651) 779-9492
Mailing address: 330 Marie Avenue 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 800870 (MN)

Other Intermediate Care Facility, Intellectual Disabilities providers in Minnesota →

Registry record

NPI: 1245324920
Entity type: Organization
NPI issued: 3 Oct 2006
Record last updated: 2 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.