Phoenix Residence, Inc.

LBN: Phoenix Residence, Inc.
Phoenix Residence, Inc. is an health care organization with primary practice located at 2168 12Th Street , White Bear Lake MN 55110. 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) 653-3713, or through Scott, Darlene M via phone (651) 227-7655.

Contact Information

Primary practice address
2168 12Th Street White Bear Lake MN 55110
Phone: (651) 653-3713
Fax: (651) 653-5784
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 1032511 1 RS Minnesota

Profile Details

NPI number 1457458812
LBN Legal business name Phoenix Residence, Inc.
DBA Doing business as
Authorized official Scott, Darlene M
Entity Organization
Organization subpart 1 No
Enumeration date Sep 20th, 2006
Last updated Jul 1st, 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 1457458812 NPPES
Minnesota MEDICAID 714417200

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