Organization · Type 2 NPI

Phoenix Residence, Inc.

Intellectual Disabilities Intermediate Care Facility · Maplewood, MN

NPI number 1134226509 Active

Practice location

2465 Carver Ave
Maplewood, MN 55119

Call (651) 702-8995 Map

Fax (651) 702-2511

Mailing address

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

Specialties and licenses

TaxonomyCodeLicense
Intellectual Disabilities Intermediate Care Facility Primary 315P00000X1033706 1 RS (MN)

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

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About NPI 1134226509

Phoenix Residence, Inc.'s National Provider Identifier is 1134226509, issued on Sep 20, 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.