Phoenix Residence, Inc.

NPI #1376649673 in Little Canada, Minnesota

Provider Information

NPI Number
1376649673
Entity Type
Organization
Organization Name
Phoenix Residence, Inc.
Primary Specialty
Intermediate Care Facility, Intellectual Disabilities
Enumeration Date
Sep 15, 2006
Last Updated
Jul 1, 2008

Practice Location

Address
645 VIKING DR E
ZIP Code
55117-1663
Phone
(651) 294-2076

Authorized Official

Name
DARLENE M SCOTT
Title
PRESIDENT/CEO
Phone
(651) 227-7655

Specialties & Taxonomy Codes

Specialty
Intermediate Care Facility, Intellectual Disabilities

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