National Provider Identifier Database

PHOENIX RESIDENCE INC
Intermediate Care Facility, Mentally Retarded

(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.


Contact Information

PHOENIX RESIDENCE, INC.
1500 AMES AVE
SAINT PAUL, MN55106-7022
Phone: 651-774-0194
Fax: 651-774-2074
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for PHOENIX RESIDENCE, INC.

NPI Number 1144326513
Legal business name
LBN
PHOENIX RESIDENCE, INC.
Authorized official DARLENE SCOTT - (PRESIDENT/CEO)
Entity Organization
Organization subpart No
Enumeration date 09/15/2006
Last updated 07/01/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • MN License #: 1032513 1 RS
  • MN Medicaid: 181633100

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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