OrganizationActive
Phoenix Residence, Inc.
NPI 1376649673 · Intellectual Disabilities Intermediate Care Facility · Little Canada, MN
Provider details
- NPI number
- 1376649673
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Authorized official
- Darlene Scott, President/Ceo
- License
- 1033704 1 RS (MN)
Practice location
645 Viking Dr E
Little Canada, MN 55117-1663
Phone: (651) 294-2076
Fax: (651) 294-2077
Mailing address
330 Marie Ave E
West St Paul, MN 55118-4011
Registry dates
- Enumerated
- 2006-09-15
- Last updated
- 2008-07-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.