Organization · Type 2 NPI

Phoenix Residence, Inc.

Intellectual Disabilities Intermediate Care Facility · Maplewood, MN

NPI number 1134217037 Active

Practice location

1685 Howard St
Maplewood, MN 55109

Call (651) 777-6754 Map

Fax (651) 779-9339

Mailing address

330 Marie Ave E
West St. Paul, MN 55118-4011

Specialties and licenses

TaxonomyCodeLicense
Intellectual Disabilities Intermediate Care Facility Primary 315P00000X801102 (MN)

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

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About NPI 1134217037

Phoenix Residence, Inc.'s National Provider Identifier is 1134217037, issued on Oct 10, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Maplewood, MN. The record was last updated on Jul 1, 2008.