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PHOENIX RESIDENCE, INC.

Intermediate Care Facility, Mentally Retarded

Mounds View, Minnesota

Provider NPI: 1649376005

Organization Information:
Organization Name:  PHOENIX RESIDENCE, INC.


Practice Location:
7717 LONG LAKE RD  MOUNDS VIEW, MN 55112 US
Tel: 763-398-3812  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
MN1032532 1 RS

Other Provider Identifiers:

IssuerNumberStateType
355474100MN05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS MN - Page 1



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