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

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NPI Details

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
1315P00000XIntermediate Care Facility, Intellectual Disabilities1033705 1 RSMINNESOTAYes

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
1617609700MEDICAIDMINNESOTA

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: 11/21/2025

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