Phoenix Residence, Inc.

LBN: Phoenix Residence, Inc.
Phoenix Residence, Inc. is an health care organization with primary practice located at 7717 Long Lake Rd , Mounds View MN 55112-6205. 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 (763) 398-3812, or through Darlene, Scott M via phone (651) 227-7655.

Contact Information

Primary practice address
7717 Long Lake Rd Mounds View MN 55112-6205
Phone: (763) 398-3812
Fax: (763) 398-3813
Website:
Map and Directions
Authorized official contact:
Name: Darlene, Scott M
Phone: (651) 227-7655

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X 1032532 1 RS Minnesota

Profile Details

NPI number 1649376005
LBN Legal business name Phoenix Residence, Inc.
DBA Doing business as
Authorized official Darlene, Scott M
Entity Organization
Organization subpart 1 No
Enumeration date Sep 15th, 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 1649376005 NPPES
Minnesota MEDICAID 355474100

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