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Phoenix Residence Inc
Intellectual Disabilities Intermediate Care Facility in Maplewood, Minnesota
NPI 1245324920

Phoenix Residence Inc is a Intellectual Disabilities Intermediate Care Facility based in West St Paul, MN. Phoenix Residence Inc practices in Maplewood, MN. The NPI Number for Phoenix Residence Inc is 1245324920 and holds a License No. 800870 (Minnesota).

The current practice location address for Phoenix Residence Inc is 1866 Furness Street, Maplewood, MN and can be reached out via phone at 651-777-6349 and via fax at 651-779-9492.

Location: 1866 Furness Street, Maplewood, MN, 55118-4011
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1245324920
Provider Name
Phoenix Residence Inc
Credential
Provider Entity Type
Organization
Address
1866 Furness Street, Maplewood, MN, 55118-4011
Phone Number
651-777-6349
Fax Number
651-779-9492
Provider Enumeration Date
10/03/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
443545100 05 MN
institution
Provider Business Practice Location Address Details
Address
1866 Furness Street
City
Maplewood
State
Minnesota
Zip
55109
Phone Number
651-777-6349
Fax Number
651-779-9492
person
Provider Business Mailing Address Details
Address
1866 Furness Street
City
Maplewood
State
Minnesota
Zip
55109
Phone Number
651-777-6349
Fax Number
651-779-9492
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
800870 (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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