OrganizationActive
Phoenix Residence, Inc.
NPI 1649376005 · Intellectual Disabilities Intermediate Care Facility · Mounds View, MN
Provider details
- NPI number
- 1649376005
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Scott Darlene, President/Ceo(651) 227-7655
- License
- 1032532 1 RS (MN)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Practice location
7717 Long Lake Rd
Mounds View, MN 55112-6205
Phone: (763) 398-3812
Fax: (763) 398-3813
Approximate (ZIP-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.