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Phoenix Residence, Inc.
Intellectual Disabilities Intermediate Care Facility in Mounds View, Minnesota
NPI 1649376005

Phoenix Residence, Inc. is a Intellectual Disabilities Intermediate Care Facility based in West St Paul, MN. Phoenix Residence, Inc. practices in Mounds View, MN. The NPI Number for Phoenix Residence, Inc. is 1649376005 and holds a License No. 1032532 1 RS (Minnesota).

The current practice location address for Phoenix Residence, Inc. is 7717 Long Lake Rd, Mounds View, MN and can be reached out via phone at 763-398-3812 and via fax at 763-398-3813.

Location: 7717 Long Lake Rd, Mounds View, MN, 55118-4011
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1649376005
Provider Name
Phoenix Residence, Inc.
Credential
Provider Entity Type
Organization
Address
7717 Long Lake Rd, Mounds View, MN, 55118-4011
Phone Number
763-398-3812
Fax Number
763-398-3813
Provider Enumeration Date
09/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
355474100 05 MN
institution
Provider Business Practice Location Address Details
Address
7717 Long Lake Rd
City
Mounds View
State
Minnesota
Zip
55112-6205
Phone Number
763-398-3812
Fax Number
763-398-3813
person
Provider Business Mailing Address Details
Address
7717 Long Lake Rd
City
Mounds View
State
Minnesota
Zip
55112-6205
Phone Number
763-398-3812
Fax Number
763-398-3813
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
1032532 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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