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Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility in Saint Paul, Minnesota
NPI 1144326513

Phoenix Residence, Inc. is a Intellectual Disabilities Intermediate Care Facility based in West St Paul, MN. Phoenix Residence, Inc. practices in Saint Paul, MN. The NPI Number for Phoenix Residence, Inc. is 1144326513 and holds a License No. 1032513 1 RS (Minnesota).

The current practice location address for Phoenix Residence, Inc. is 1500 Ames Ave, Saint Paul, MN and can be reached out via phone at 651-774-0194 and via fax at 651-774-2074.

Location: 1500 Ames Ave, Saint Paul, MN, 55118-4011
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1144326513
Provider Name
Phoenix Residence, Inc.
Credential
Provider Entity Type
Organization
Address
1500 Ames Ave, Saint Paul, MN, 55118-4011
Phone Number
651-774-0194
Fax Number
651-774-2074
Provider Enumeration Date
09/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
181633100 05 MN
institution
Provider Business Practice Location Address Details
Address
1500 Ames Ave
City
Saint Paul
State
Minnesota
Zip
55106-7022
Phone Number
651-774-0194
Fax Number
651-774-2074
person
Provider Business Mailing Address Details
Address
1500 Ames Ave
City
Saint Paul
State
Minnesota
Zip
55106-7022
Phone Number
651-774-0194
Fax Number
651-774-2074
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
1032513 1 RS (Minnesota)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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