PHOENIX RESIDENCE, INC. is an intermediate care facility mentally retarded in Saint Paul, MN. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PHOENIX RESIDENCE, INC. NPI is 1417053893. The provider is registered as an organization entity type.
The provider's business location address is:
1538 POINT DOUGLAS RD S
SAINT PAUL, MN
ZIP 55119-006
Phone: (651) 739-6930
Fax: (651) 739-1055
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 24D1042493 - 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.