PHOENIX RESIDENCE INC (NPI# 1245324920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245324920 |
| Entity Type | Organization |
| Organization Name | PHOENIX RESIDENCE INC |
| Practice Address |
1866 Furness Street Maplewood MN 55109 |
| Mailing Address |
330 Marie Avenue E West St Paul MN 55118-4011 |
| Practice Telephone | 6517776349 |
| Practice Fax Number | 6517799492 |
| Mailing Telephone | 6512277655 |
| Mailing Fax Number | 6512276847 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-07-02 |
| Authorized Official Name | 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 | 800870 | MN | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 443545100 | 05 |
| Street Address |
1866 FURNESS STREET |
| City | MAPLEWOOD |
| State | MN |
| Zip Code | 55109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063828 | Jodi May Begordis | Registered Nurse | 2586 7th Ave East, Suite 302, North St Paul, MN 55109 | 2020-05-06 |
| 1467917146 | Alejandro Diez Freire | Social Worker | 2468 Germain St, Maplewood, MN 55109 | 2019-02-06 |
| 1679099667 | Rochelle Marie Clarke | Registered Nurse | 2586 7th Ave East Suite 302, North Saint Paul, MN 55109 | 2017-08-21 |
| 1497298210 | Salams Care Residential, LLC | Home Health | 2240 Ide Ct, Maplewood, MN 55109 | 2016-11-28 |
| 1093199630 | Garry Allen | Psychologist | 2345 Ariel St North Mail Stop 13601a, Maplewood, MN 55109 | 2015-07-14 |
| 1700264751 | Matthew Seng Thao | Student in an Organized Health Care Education/Training Program | 1470 Gervais Ave, Maplewood, MN 55109 | 2015-05-11 |
| 1326458340 | Chong Chang | Counselor | 1705 Cope Ave E Ste I, Maplewood, MN 55109 | 2014-04-29 |
| 1619396488 | Leah Anne Downey | Occupational Therapist | 2399 Ariel St. N., Children's Theraplay, LLC, Maplewood, MN 55109 | 2014-04-09 |
| 1356765440 | Group Health Plan, Inc | Clinic/Center | 2520 12th Ave E, North St Paul, MN 55109 | 2014-02-10 |
| 1336560275 | Veneman Dental Care, Pa | Dentist | 1774 Cope Ave, Suite 110, Maplewood, MN 55109 | 2013-12-19 |
| Find all providers in zip 55109 | ||||
| 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 |
|---|---|---|---|---|
| 1205111770 | Rem Ramsey, Inc. | Intermediate Care Facility, Mentally Retarded | 975 Lakewood Drive, Maplewood, MN 55119 | 2011-10-17 |
| 1306171939 | Rem Ramsey, Inc. | Intermediate Care Facility, Mentally Retarded | 797 Mayhill Rd N, Maplewood, MN 55119-3828 | 2009-10-15 |
| 1811052053 | Outcomes, Inc. | Intermediate Care Facility, Mentally Retarded | 2951 Bartelmy Ln, Maplewood, MN 55109-1574 | 2006-12-27 |
| 1336203165 | Dakota Communities Inc | Intermediate Care Facility, Mentally Retarded | 1362 Cope Ave E, Maplewood, MN 55109-2657 | 2006-12-19 |
| 1568525129 | Dakota Communities Inc | Intermediate Care Facility, Mentally Retarded | 2675 Brookview Dr E, Maplewood, MN 55119-4748 | 2006-12-18 |
| 1457414096 | Dakota Communities, Inc | Intermediate Care Facility, Mentally Retarded | 1951 Larpenteur Ave E, Maplewood, MN 55109-4705 | 2006-12-18 |
| 1134217037 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 1685 Howard St, Maplewood, MN 55109 | 2006-10-10 |
| 1134226509 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 2465 Carver Ave, Maplewood, MN 55119 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922502418 | Harry Meyering Center, Inc. | Intermediate Care Facility, Mentally Retarded | 2050 Haughton Ave, North Mankato, MN 56003-1416 | 2018-03-20 |
| 1114385085 | Lutheran Social Service of Minnesota | Intermediate Care Facility, Mentally Retarded | 11754 191 1/2 Ave Nw, Elk River, MN 55330-1367 | 2016-02-05 |
| 1255797718 | Lutheran Social Service of Minnesota | Intermediate Care Facility, Mentally Retarded | 497 Gates Ave Nw, Elk River, MN 55330-2633 | 2016-01-13 |
| 1891195608 | Prairie Community Services | Intermediate Care Facility, Mentally Retarded | 2203 Rolling Green Ln, North Mankato, MN 56003-4459 | 2014-08-28 |
| 1336560333 | Rem Woodvale, Inc. Cottonwood | Intermediate Care Facility, Mentally Retarded | 2311 9th Avenue Sw, Austin, MN 55912 | 2013-12-18 |
| 1801228937 | Rem River Bluffs, Inc. Pinewood | Intermediate Care Facility, Mentally Retarded | 2631 Pinewood Ridge Dr Se, Rochester, MN 55904-6227 | 2013-07-31 |
| 1003073487 | Harmony Homes of Minnesota LLC | Intermediate Care Facility, Mentally Retarded | 7935 Drake Rd, Woodbury, MN 55125-1446 | 2008-05-22 |
| 1508033580 | Allendale House | Intermediate Care Facility, Mentally Retarded | 3108 Highway 52 N, Rochester, MN 55901-1916 | 2008-05-09 |
| 1083880488 | Bear Creek Services | Intermediate Care Facility, Mentally Retarded | 3108 Hwy 52 N, Rochester, MN 55901-1916 | 2008-05-06 |
| 1710152202 | Oakridge Homes of Wadena, Inc. | Intermediate Care Facility, Mentally Retarded | 1021 Industrial Park Road, Brainerd, MN 56401-8338 | 2008-04-25 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PHOENIX RESIDENCE INC.
| 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.