Phoenix Residence Inc

LBN: Phoenix Residence Inc
Phoenix Residence Inc is an health care organization with primary practice located at 1866 Furness Street , Maplewood MN 55109. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, which is considered as the primary health care specialty. Phoenix Residence Inc can be contacted via phone (651) 777-6349, or through Scott, Darlene M via phone (651) 227-7655.

Contact Information

Primary practice address
1866 Furness Street Maplewood MN 55109
Phone: (651) 777-6349
Fax: (651) 779-9492
Website:
Map and Directions
Authorized official contact:
Name: Scott, Darlene M
Phone: (651) 227-7655

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X 800870 Minnesota

Profile Details

NPI number 1245324920
LBN Legal business name Phoenix Residence Inc
DBA Doing business as
Authorized official Scott, Darlene M
Entity Organization
Organization subpart 1 No
Enumeration date Oct 3rd, 2006
Last updated Jul 2nd, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245324920 NPPES
Minnesota MEDICAID 443545100

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