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PHOENIX RESIDENCE, INC.
NPI 1376649673
Intermediate Care Facility, Intellectual Disabilities in Little Canada, MN

Active since September 15, 2006
645 VIKING DR E, LITTLE CANADA, MN 55117(651) 294-2076(651) 294-2077 Get Directions Write a Review

NPPES record last updated: July 1, 2008. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Phoenix Residence, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHOENIX RESIDENCE, INC. (NPI 1376649673) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Little Canada, Minnesota and active in the NPI registry since September 2006. The organization lists Darlene M Scott, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1376649673
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NamePHOENIX RESIDENCE, INC.
Location Address645 VIKING DR ELittle Canada, MN 55117-1663
Mailing Address330 Marie Ave EWest St Paul, MN 55118-4011 · (651) 227-7655 · Fax (651) 227-6847
Phone(651) 294-2076
Fax(651) 294-2077
Organization SubpartNo
Authorized OfficialDarlene M ScottPresident/ceo · (651) 227-7655
Enumeration DateSeptember 15, 2006
Last NPPES UpdateJuly 1, 2008
✔ NPI 1376649673 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
License✔ Licensed in MN · 1033704 1 RS
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
645 VIKING DR E, Little Canada, MN 55117
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Other Identifiers 1

Medicaid957543000MN

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Phoenix Residence, Inc.'s NPI number?

The NPI number for Phoenix Residence, Inc. is 1376649673. It was assigned to this organization in the NPPES registry on September 15, 2006.

Where is Phoenix Residence, Inc. located?

Phoenix Residence, Inc. is located at 645 Viking Dr E, Little Canada, MN 55117. The listed phone number is (651) 294-2076.

What is Phoenix Residence, Inc.'s specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

When was this NPI record last updated?

The NPPES record for Phoenix Residence, Inc. was last updated on July 1, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.