Organization · Type 2 NPI

Phoenix Residence Inc

Intellectual Disabilities Intermediate Care Facility · Maplewood, MN

NPI number 1245324920 Active

Practice location

1866 Furness Street
Maplewood, MN 55109

Call (651) 777-6349 Map

Fax (651) 779-9492

Mailing address

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

Specialties and licenses

TaxonomyCodeLicense
Intellectual Disabilities Intermediate Care Facility Primary 315P00000X800870 (MN)

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

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About NPI 1245324920

Phoenix Residence Inc's National Provider Identifier is 1245324920, issued on Oct 3, 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 2, 2008.