Organization · Type 2 NPI
Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility · Arden Hills, MN
NPI number
1811093206
Active
Practice location
1769 Janet Ct
Arden Hills, MN 55112-2861
Fax (651) 294-2075
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 | 1033705 1 RS (MN) |
Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.
About NPI 1811093206
Phoenix Residence, Inc.'s National Provider Identifier is 1811093206, issued on Sep 15, 2006. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Arden Hills, MN. The record was last updated on Jul 1, 2008.