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Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility in White Bear Lake, Minnesota
NPI 1457458812

Phoenix Residence, Inc. is a Intellectual Disabilities Intermediate Care Facility based in West St Paul, MN. Phoenix Residence, Inc. practices in White Bear Lake, MN. The NPI Number for Phoenix Residence, Inc. is 1457458812 and holds a License No. 1032511 1 RS (Minnesota).

The current practice location address for Phoenix Residence, Inc. is 2168 12Th Street, White Bear Lake, MN and can be reached out via phone at 651-653-3713 and via fax at 651-653-5784.

Location: 2168 12Th Street, White Bear Lake, MN, 55118-4011
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1457458812
Provider Name
Phoenix Residence, Inc.
Credential
Provider Entity Type
Organization
Address
2168 12Th Street, White Bear Lake, MN, 55118-4011
Phone Number
651-653-3713
Fax Number
651-653-5784
Provider Enumeration Date
09/20/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
714417200 05 MN
institution
Provider Business Practice Location Address Details
Address
2168 12Th Street
City
White Bear Lake
State
Minnesota
Zip
55110
Phone Number
651-653-3713
Fax Number
651-653-5784
person
Provider Business Mailing Address Details
Address
2168 12Th Street
City
White Bear Lake
State
Minnesota
Zip
55110
Phone Number
651-653-3713
Fax Number
651-653-5784
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
1032511 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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