Local City Search for Care Homes, Nursing Homes, Assisted Living, Skilled Nursing and Home CarePHOENIX 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:
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:
7717 LONG LAKE RD MOUNDS VIEW, MN 55112 US
Tel: 763-398-3812 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 | 1032532 1 RS |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 355474100 | MN | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
