OrganizationActive
Phoenix Residence, Inc.
NPI 1417053893 · Intellectual Disabilities Intermediate Care Facility · Saint Paul, MN
Provider details
- NPI number
- 1417053893
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Darlene Scott, President/Ceo(651) 227-7655
- License
- 1032512 1RS (MN)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1538 Point Douglas Rd S
Saint Paul, MN 55119-6006
Phone: (651) 739-6930
Fax: (651) 739-1055
Street-level locationGet directions
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.