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Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility in Saint Paul, Minnesota
NPI 1417053893

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 1417053893 and holds a License No. 1032512 1RS (Minnesota).

The current practice location address for Phoenix Residence, Inc. is 1538 Point Douglas Rd S, Saint Paul, MN and can be reached out via phone at 651-739-6930 and via fax at 651-739-1055.

Location: 1538 Point Douglas Rd S, Saint Paul, MN, 55118-4011
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1417053893
Provider Name
Phoenix Residence, Inc.
Credential
Provider Entity Type
Organization
Address
1538 Point Douglas Rd S, Saint Paul, MN, 55118-4011
Phone Number
651-739-6930
Fax Number
651-739-1055
Provider Enumeration Date
09/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
849607200 05 MN
institution
Provider Business Practice Location Address Details
Address
1538 Point Douglas Rd S
City
Saint Paul
State
Minnesota
Zip
55119-6006
Phone Number
651-739-6930
Fax Number
651-739-1055
person
Provider Business Mailing Address Details
Address
1538 Point Douglas Rd S
City
Saint Paul
State
Minnesota
Zip
55119-6006
Phone Number
651-739-6930
Fax Number
651-739-1055
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
1032512 1RS (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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