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Phoenix — NPI 1972118438, North Branch, MN | NPI Central

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NPI 1972118438

OrganizationActive

Phoenix

NPI 1972118438 · Voluntary or Charitable Agency · North Branch, MN

Provider details

NPI number: 1972118438
Entity type: Organization
Primary specialty: Voluntary or Charitable AgencyAgencies
Organization subpart: No
Authorized official: Jeremy Kortus, Co-Founder(651) 795-8759

Specialties & taxonomies

Voluntary or Charitable AgencyPrimary251V00000X
Agencies

Practice location

6697 Elm St

North Branch, MN 55056-7045

Phone: (651) 795-8759

Approximate (ZIP-level) locationGet directions

More MN providers

Mailing address

6697 Elm St

North Branch, MN 55056-7045

Other names (DBA / former)

Doing business as: Phoenix

Registry dates

Enumerated: 2020-09-11
Last updated: 2020-09-11
Certified: 2020-09-11

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.