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Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility in Newport, Minnesota
NPI 1376649772

Phoenix Residence, Inc. is a Intellectual Disabilities Intermediate Care Facility based in West St Paul, MN. Phoenix Residence, Inc. practices in Newport, MN. The NPI Number for Phoenix Residence, Inc. is 1376649772 and holds a License No. 1033707 1 RS (Minnesota).

The current practice location address for Phoenix Residence, Inc. is 351 14Th St, Newport, MN and can be reached out via phone at 651-459-4419 and via fax at 651-459-2269.

Location: 351 14Th St, Newport, MN, 55118-4011
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1376649772
Provider Name
Phoenix Residence, Inc.
Credential
Provider Entity Type
Organization
Address
351 14Th St, Newport, MN, 55118-4011
Phone Number
651-459-4419
Fax Number
651-459-2269
Provider Enumeration Date
09/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
478319100 05 MN
institution
Provider Business Practice Location Address Details
Address
351 14Th St
City
Newport
State
Minnesota
Zip
55055-1127
Phone Number
651-459-4419
Fax Number
651-459-2269
person
Provider Business Mailing Address Details
Address
351 14Th St
City
Newport
State
Minnesota
Zip
55055-1127
Phone Number
651-459-4419
Fax Number
651-459-2269
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
1033707 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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