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PHOENIX RESIDENCE, INC.
NPI 1811093206
Intermediate Care Facility, Intellectual Disabilities in Arden Hills, MN

Active since September 15, 2006CLIA 24D1042494 · Waiver
1769 JANET CT, ARDEN HILLS, MN 55112(651) 294-2074(651) 294-2075 Get Directions Write a Review

NPPES record last updated: July 1, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Phoenix Residence, Inc. NPPES

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

PHOENIX RESIDENCE, INC. (NPI 1811093206) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Arden Hills, Minnesota and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through April 11, 2028 and lists Darlene M Scott, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1811093206
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NamePHOENIX RESIDENCE, INC.
Location Address1769 JANET CTArden Hills, MN 55112-2861
Mailing Address330 Marie Ave EWest St Paul, MN 55118-4011 · (651) 227-7655 · Fax (651) 227-6847
Phone(651) 294-2074
Fax(651) 294-2075
Organization SubpartNo
Authorized OfficialDarlene M ScottPresident/ceo · (651) 227-7655
Enumeration DateSeptember 15, 2006
Last NPPES UpdateJuly 1, 2008
✔ NPI 1811093206 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 · 1033705 1 RS
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
1769 JANET CT, Arden Hills, MN 55112
Open in Google Maps ↗

Other Identifiers 1

Medicaid617609700MN

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D1042494

Phoenix Residence Janet Court · Arden Hills, MN
Active · expires Apr 11, 2028
CLIA Number24D1042494
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateApril 12, 2026
Certificate Expiration DateApril 11, 2028
Laboratory DirectorKimberly E. Human
Laboratory Phone(651) 294-2074
Laboratory LocationPhoenix Residence Janet Court1769 Janet Court, Arden Hills, MN 55112
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 1811093206. 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 1769 Janet Ct, Arden Hills, MN 55112. The listed phone number is (651) 294-2074.

What is Phoenix Residence, Inc.'s specialty?

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

Does Phoenix Residence, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1042494) is associated with this NPI, valid through April 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

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.