Phoenix Residence, Inc.

NPI 1134217037

Information of Phoenix Residence, Inc.

The NPI 1134217037 is an Organization type. NPI No 1134217037 belongs to Phoenix Residence, Inc.. Phoenix Residence, Inc. specializes in Intermediate Care Facility, Mentally Retarded. is practising at 1685 Howard St, Maplewood, Minnesota 55109. You can also contact him via phone number (651) 777-6754.

Practice address located

  • 1685 Howard St
  • Maplewood, Minnesota 55109
  • (651) 777-6754
  • (651) 777-6754

Mailling address located

  • 330 Marie Ave E
  • West St Paul, Minnesota 55118
  • (651) 227-7655
  • (651) 227-6847
NPI No 1134217037
Primary Taxonomy
Authorized Official
Specialty of the provider
PrimaryTaxonomy CodeClassificationLicense NumberLicense State
Yes315P00000XIntermediate Care Facility, Mentally Retarded801102Minnesota
Identifier for this provider
StateIdentifierTypeIssuer
MN273545800Medicaidn/a
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