Phoenix Residence, Inc. in White Bear Lake - Intermediate Care Facility, Intellectual Disabilities
Phoenix Residence, Inc. - NPI 1457458812
Phoenix Residence, Inc. is a Intermediate Care Facility, Intellectual Disabilities in White Bear Lake, 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 1457458812. The last update date is 2008-07-01.
Phoenix Residence, Inc.'s current location address is 2168 12th Street, White Bear Lake, Minnesota. You can contact this provider via phone number 6516533713 and fax number 6516535784. The mailing address for Phoenix Residence, Inc. is 2168 12th Street, White Bear Lake, Minnesota. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Phoenix Residence, Inc. |
|---|---|
| Address | 2168 12th Street, White Bear Lake, Minnesota |
| Phone Number | 6516533713 |
| Fax Number | 6516535784 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT/ |
|---|---|
| Authorized Official Name | Scott M Darlene |
| Telephone Number | 6512277655 |
NPI Number Detail
| NPI Number | 1457458812 |
|---|---|
| Provider Enumeration Date | 2006-09-20 |
| Last Updated Date | 2008-07-01 |
Provider Mailing Address Detail
| Address | 2168 12th Street |
|---|---|
| City | White Bear Lake |
| State | Minnesota (MN) |
| Post Code | 55110 |
| Phone Number | 6516533713 |
| Fax Number | 6516535784 |
Provider's Primary Taxonomy Detail
| Speciality | Intermediate Care Facility, Intellectual Disabilities |
|---|---|
| Taxonomy | 315P00000X |
| Licence No | 1032511 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 |
|---|---|---|---|
| 714417200 | MN | -- |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Phoenix Residence, Inc. by the Centers for Medicare & Medicaid Services?
The Phoenix Residence, Inc. has been issued the NPI (National Provider Identifier) 1457458812, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete street address where Phoenix Residence, Inc. is physically located?
The Phoenix Residence, Inc. is physically situated at the following address: 2168 12Th Street, White Bear Lake, MN, 55110.
What is Phoenix Residence, Inc.'s primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Phoenix Residence, Inc. is Intermediate Care Facility, Intellectual Disabilities, and the corresponding taxonomy classification code for this specialized field is 315P00000X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1457458812 to Phoenix Residence, Inc.?
The Centers for Medicare & Medicaid Services originally issued the 1457458812 to Phoenix Residence, Inc. on 2006-09-20.
As of what date was the information regarding Phoenix Residence, Inc., such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to Phoenix Residence, Inc., including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2008-07-01.
NPI Number: 1336142389
Address: Po Box 2004, East Syracuse, NY