Organization · Type 2 NPI
Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility · Little Canada, MN
NPI number
1376649673
Active
Practice location
645 Viking Dr E
Little Canada, MN 55117-1663
Fax (651) 294-2077
Mailing address
330 Marie Ave E
West St. Paul, MN 55118-4011
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual Disabilities Intermediate Care Facility Primary | 315P00000X | 1033704 1 RS (MN) |
Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.
About NPI 1376649673
Phoenix Residence, Inc.'s National Provider Identifier is 1376649673, issued on Sep 15, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Little Canada, MN. The record was last updated on Jul 1, 2008.