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Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility in Little Canada, Minnesota
NPI 1376649673

Phoenix Residence, Inc. is a Intellectual Disabilities Intermediate Care Facility based in West St Paul, MN. Phoenix Residence, Inc. practices in Little Canada, MN. The NPI Number for Phoenix Residence, Inc. is 1376649673 and holds a License No. 1033704 1 RS (Minnesota).

The current practice location address for Phoenix Residence, Inc. is 645 Viking Dr E, Little Canada, MN and can be reached out via phone at 651-294-2076 and via fax at 651-294-2077.

Location: 645 Viking Dr E, Little Canada, MN, 55118-4011
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1376649673
Provider Name
Phoenix Residence, Inc.
Credential
Provider Entity Type
Organization
Address
645 Viking Dr E, Little Canada, MN, 55118-4011
Phone Number
651-294-2076
Fax Number
651-294-2077
Provider Enumeration Date
09/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
957543000 05 MN
institution
Provider Business Practice Location Address Details
Address
645 Viking Dr E
City
Little Canada
State
Minnesota
Zip
55117-1663
Phone Number
651-294-2076
Fax Number
651-294-2077
person
Provider Business Mailing Address Details
Address
645 Viking Dr E
City
Little Canada
State
Minnesota
Zip
55117-1663
Phone Number
651-294-2076
Fax Number
651-294-2077
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
1033704 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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