Phoenix Residence, Inc.
NPI #1457458812 in White Bear Lake, Minnesota
Provider Information
- NPI Number
- 1457458812
- Entity Type
- Organization
- Organization Name
- Phoenix Residence, Inc.
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Sep 20, 2006
- Last Updated
- Jul 1, 2008
Practice Location
- Address
- 2168 12TH STREET
- City
- White Bear Lake
- State
- Minnesota
- ZIP Code
- 55110
- Phone
- (651) 653-3713
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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