PHOENIX RESIDENCE INC. NPI 1811093206

NPI Information

NPI: 1811093206
Provider Name: PHOENIX RESIDENCE, INC.
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

CLIA Number: 24D1042494

Address:
1769 JANET CT
ARDEN HILLS, MN
ZIP 55112
Phone: (651) 294-2074
Get Directions

PHOENIX RESIDENCE, INC. is an intermediate care facility mentally retarded in Arden Hills, MN. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PHOENIX RESIDENCE, INC. NPI is 1811093206. The provider is registered as an organization entity type.

The provider's business location address is:

1769 JANET CT
ARDEN HILLS, MN
ZIP 55112-861
Phone: (651) 294-2074
Fax: (651) 294-2075

The provider's authorized official is Darlene M Scott .
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 24D1042494 - 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.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		1033705 1 RS	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	617609700	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »