PHOENIX RESIDENCE, INC. (NPI# 1134215700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134215700 |
| Entity Type | Organization |
| Organization Name | PHOENIX RESIDENCE, INC. |
| Practice Address |
785 E County Road E Vadnais Heights NE 55127 |
| Mailing Address |
330 Marie Ave E West St Paul MN 55118-4011 |
| Practice Telephone | 6514869342 |
| Practice Fax Number | 6514869349 |
| Mailing Telephone | 6512277655 |
| Mailing Fax Number | 6512276847 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-07-01 |
| Authorized Official Name | MRS. DARLENE M SCOTT (PRESIDENT/CEO) |
| Authorized Official Telephone | 6512277655 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 805075 | MN | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 314045800 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134217037 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 1685 Howard St, Maplewood, MN 55109 | 2006-10-10 |
| 1831285816 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 1336 E County Road E, Vadnais Heights, MN 55110 | 2006-10-05 |
| 1134226509 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 2465 Carver Ave, Maplewood, MN 55119 | 2006-09-20 |
| 1457458812 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 2168 12th Street, White Bear Lake, MN 55110 | 2006-09-20 |
| 1376649772 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 351 14th St, Newport, MN 55055-1127 | 2006-09-15 |
| 1144326513 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 1500 Ames Ave, Saint Paul, MN 55106-7022 | 2006-09-15 |
| 1811093206 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 1769 Janet Ct, Arden Hills, MN 55112-2861 | 2006-09-15 |
| 1376649673 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 645 Viking Dr E, Little Canada, MN 55117-1663 | 2006-09-15 |
| 1649376005 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 7717 Long Lake Rd, Mounds View, MN 55112-6205 | 2006-09-15 |
| 1417053893 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 1538 Point Douglas Rd S, Saint Paul, MN 55119-6006 | 2006-09-15 |
| Street Address |
785 E COUNTY ROAD E |
| City | VADNAIS HEIGHTS |
| State | NE |
| Zip Code | 55127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013514058 | Taylor Nessa Draves | Behavior Technician | 1011 Meadowlamds Dr, White Bear Lake, MN 55127 | 2020-10-02 |
| 1578104196 | Patricia Lynn Bina | Technician | 3677 Centerville Rd, Vadnais Heights, MN 55127 | 2019-10-04 |
| 1023538469 | Dignicare Senior Management of Vadnais | Assisted Living Facility | 580 Liberty Way, Vadnais Heights, MN 55127 | 2017-06-27 |
| 1548610207 | Golden Elderly Care Suites LLC | Assisted Living Facility | 4624 Stoddart Circle, White Bear Lake, MN 55127 | 2016-06-14 |
| 1811018203 | Adam F Curtis | Dentist | 925 East County Road E, Suite 185, Vadnais Heights, MN 55127 | 2007-04-03 |
| 1861404790 | Gerald James Pease | Optometrist | 850 East Co Rd E, Walmart Vision Center, Vadnais Heights, MN 55127 | 2006-08-12 |
| 1235629395 | Suite Living Senior Management | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55127 | 2018-05-15 |
| 1760986624 | Diandra Shakira Williams | Physician Assistant | 3580 Arcade St, Vadnais Heights, MN 55127 | 2018-03-23 |
| 1811370729 | Sonya L Knudson | Psychologist | 4444 Centerville Rd Ste 235, White Bear Lake, MN 55127 | 2015-07-09 |
| 1801275672 | Anne M Mcdonald | Social Worker | 4444 Centerville Road, Suite 235, White Bear Lake, MN 55127 | 2015-05-26 |
| Find all providers in zip 55127 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851456099 | Outcomes, Inc. | Intermediate Care Facility, Mentally Retarded | 531 Springhill Rd, Vadnais Heights, MN 55127-8529 | 2006-12-27 |
| 1831285816 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 1336 E County Road E, Vadnais Heights, MN 55110 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487952297 | Mosaic | Intermediate Care Facility, Mentally Retarded | 2000 W Park Ave, Norfolk, NE 68701-4701 | 2011-03-02 |
| 1790003614 | Mosaic | Intermediate Care Facility, Mentally Retarded | 1517 Hope St, Grand Island, NE 68801-7101 | 2010-05-17 |
| 1073831996 | Mosaic | Intermediate Care Facility, Mentally Retarded | 2814 S 169 St, Omaha, NE 68116 | 2010-05-17 |
| 1982922803 | Mosaic | Intermediate Care Facility, Mentally Retarded | 5806 S 147th St, Omaha, NE 68137-2538 | 2010-05-17 |
| 1609194521 | Mosaic | Intermediate Care Facility, Mentally Retarded | 1433 Grandview Ave, Papillion, NE 68046-5754 | 2010-05-17 |
| 1417275546 | Mosaic | Intermediate Care Facility, Mentally Retarded | 2215 Meadow Lark Ln, York, NE 68467-1021 | 2010-05-13 |
| 1720273386 | Mosaic | Intermediate Care Facility, Mentally Retarded | 2915 W Faidley Ave, Grand Island, NE 68803-4108 | 2007-09-07 |
| 1972706885 | Mosaic | Intermediate Care Facility, Mentally Retarded | 1044 23rd Rd, Axtell, NE 68924-3679 | 2007-06-07 |
| 1215383120 | Beatrice State Developmental Center | Intermediate Care Facility, Mentally Retarded | 3000 Lincoln St, Beatrice, NE 68310-3319 | 2016-05-10 |
| 1124452800 | State of Nebraska Dept. of Admin. Services | Intermediate Care Facility, Mentally Retarded | 3000 Lincoln St, Lake Street, Beatrice, NE 68310-3319 | 2013-08-29 |
| Find all providers with the same taxonomy | ||||
| City | VADNAIS HEIGHTS |
| Zip Code | 55127 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.