Phoenix Residence, Inc. in Little Canada - Intermediate Care Facility, Intellectual Disabilities
Phoenix Residence, Inc. - NPI 1376649673
Phoenix Residence, Inc. is a Intermediate Care Facility, Intellectual Disabilities in Little Canada, Minnesota. Phoenix Residence, Inc. practices all healthcare services and medical treatments related to Intermediate Care Facility, Intellectual Disabilities. The NPI Number for Phoenix Residence, Inc. is 1376649673. The last update date is 2008-07-01.
Phoenix Residence, Inc.'s current location address is 645 Viking Dr E, Little Canada, Minnesota. You can contact this provider via phone number 6512942076 and fax number 6512942077. The mailing address for Phoenix Residence, Inc. is 645 Viking Dr E, Little Canada, Minnesota. To know further, please read the information below!
Provider Profile Detail
Provider Organization | Phoenix Residence, Inc. |
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Address | 645 Viking Dr E, Little Canada, Minnesota |
Phone Number | 6512942076 |
Fax Number | 6512942077 |
Sole Proprietor | -- |
Credentials | -- |
Authorized Official
Title or Position | PRESIDENT/ |
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Authorized Official Name | Scott M Darlene |
Telephone Number | 6512277655 |
NPI Number Detail
NPI Number | 1376649673 |
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Provider Enumeration Date | 2006-09-15 |
Last Updated Date | 2008-07-01 |
Provider Mailing Address Detail
Address | 645 Viking Dr E |
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City | Little Canada |
State | Minnesota (MN) |
Post Code | 551171663 |
Phone Number | 6512942076 |
Fax Number | 6512942077 |
Provider's Primary Taxonomy Detail
Speciality | Intermediate Care Facility, Intellectual Disabilities |
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Taxonomy | 315P00000X |
Licence No | 1033704 1 RS |
Definition: An intermediate care facility providing services for individuals with intellectual disabilities. |
Provider's Other Legacy Identifiers
Identifier | Identifier Type | Identifier State | Identifier Issuer |
---|---|---|---|
957543000 | MN | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Phoenix Residence, Inc. by the Centers for Medicare & Medicaid Services (CMS)?
The Phoenix Residence, Inc. has been assigned the NPI (National Provider Identifier) 1376649673. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Could you please provide the complete physical location address of Phoenix Residence, Inc.?
The Phoenix Residence, Inc. is physically situated at 645 Viking Dr E, in the city of Little Canada, state of MN, with the postal code 551171663.
What is Phoenix Residence, Inc.'s specialized field of practice, and what is the corresponding taxonomy classification code?
The Phoenix Residence, Inc.'s area of specialization is Intermediate Care Facility, Intellectual Disabilities, and the corresponding taxonomy code that categorizes this field of practice is 315P00000X.
On what date was the 1376649673 assigned to Phoenix Residence, Inc.?
The Phoenix Residence, Inc. was issued its 1376649673 on 2006-09-15, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the Phoenix Residence, Inc.'s details last updated?
The information pertaining to the Phoenix Residence, Inc., including its address, specialty, and other details, was most recently updated on 2008-07-01.