Organization · Type 2 NPI
Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility · Newport, MN
NPI number
1376649772
Active
Practice location
351 14th St
Newport, MN 55055-1127
Fax (651) 459-2269
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 | 1033707 1 RS (MN) |
Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.
About NPI 1376649772
Phoenix Residence, Inc.'s National Provider Identifier is 1376649772, issued on Sep 15, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Newport, MN. The record was last updated on Jul 1, 2008.