Local City Search for Care Homes, Nursing Homes, Assisted Living, Skilled Nursing and Home CarePHOENIX RESIDENCE, INC.
Intermediate Care Facility, Mentally Retarded
White Bear Lake, Minnesota
Provider NPI: 1457458812
Organization Information:Organization Name: PHOENIX RESIDENCE, INC.
Practice Location:
2168 12TH STREET WHITE BEAR LAKE, MN 55110 US
Tel: 651-653-3713 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
2168 12TH STREET WHITE BEAR LAKE, MN 55110 US
Tel: 651-653-3713 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | MN | 1032511 1 RS |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 714417200 | MN | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
