PHOENIX RESIDENCE, INC. is an intermediate care facility mentally retarded in Mounds View, MN. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PHOENIX RESIDENCE, INC. NPI is 1649376005. The provider is registered as an organization entity type.
The provider's business location address is:
7717 LONG LAKE RD
MOUNDS VIEW, MN
ZIP 55112-205
Phone: (763) 398-3812
Fax: (763) 398-3813
The provider's authorized official is Scott M Darlene .
The authorized official title is President/ceo and has the following contact phone number (651) 227-7655.
The CLIA number assigned to this NPI record is 24D1042487 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 9/15/2006 and was last updated on 7/1/2008.