Organization · Type 2 NPI
Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility · Mounds View, MN
NPI number
1649376005
Active
Practice location
7717 Long Lake Rd
Mounds View, MN 55112-6205
Fax (763) 398-3813
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 | 1032532 1 RS (MN) |
Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.
Other intellectual disabilities intermediate care facility providers in Mounds View
About NPI 1649376005
Phoenix Residence, Inc.'s National Provider Identifier is 1649376005, issued on Sep 15, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Mounds View, MN. The record was last updated on Jul 1, 2008.