PHOENIX RESIDENCE, INC. (NPI# 1417053893) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417053893 |
| Entity Type | Organization |
| Organization Name | PHOENIX RESIDENCE, INC. |
| Practice Address |
1538 Point Douglas Rd S Saint Paul MN 55119-6006 |
| Mailing Address |
330 Marie Ave E West St Paul MN 55118-4011 |
| Practice Telephone | 6517396930 |
| Practice Fax Number | 6517391055 |
| Mailing Telephone | 6512277655 |
| Mailing Fax Number | 6512276847 |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2008-07-01 |
| 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 | 1032512 1RS | MN | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 849607200 | 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 |
| 1134215700 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 785 E County Road E, Vadnais Heights, NE 55127 | 2006-10-04 |
| 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 |
| Street Address |
1538 POINT DOUGLAS RD S |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55119-6006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811520307 | Restorative Healing & Counseling, LLC | Social Worker | 385 Londin Place, St. Paul, MN 55119 | 2020-02-13 |
| 1891282059 | Tyller Robert | Specialist/Technologist | 2594 Montana Ave E, Maplewood, MN 55119 | 2018-04-13 |
| 1477081032 | Katarzyna Zelichowski | Dentist | 1790 7th St. E, St.paul, MN 55119 | 2017-05-26 |
| 1952769333 | Rufus Zarzar | Non-emergency Medical Transport (VAN) | 230 Kipling St S # C6, St Paul, MN 55119 | 2016-02-01 |
| 1144611427 | Eric Michael Weisnicht | Chiropractor | 165 Mcknight Road N, Apt 105, Saint Paul, MN 55119 | 2015-02-09 |
| 1295147981 | Lauri Elizabeth Goetz | Licensed Practical Nurse | 2092 Case Ave E, Saint Paul, MN 55119 | 2014-05-29 |
| 1205111770 | Rem Ramsey, Inc. | Intermediate Care Facility, Mentally Retarded | 975 Lakewood Drive, Maplewood, MN 55119 | 2011-10-17 |
| 1528391976 | Kc Healthcare Services | Home Health | 295 Mcnight Road South, St Paul, MN 55119 | 2009-09-16 |
| 1073759510 | Life Fountain Home Health Care Inc | Home Health | 1380 Currie St N, Maplewood, MN 55119 | 2009-01-06 |
| 1295858991 | Dental Delivery Systems St Paul, Pa | Dentist | 1790 7th Street E., St. Paul, MN 55119 | 2007-04-09 |
| Find all providers in zip 55119 | ||||
| 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 |
|---|---|---|---|---|
| 1134283518 | Axis Minnesota, Inc. | Intermediate Care Facility, Mentally Retarded | 1586 Seneca Trl, Saint Paul, MN 55110-5882 | 2006-12-20 |
| 1750467577 | Our House of Minnesota, Inc. I | Intermediate Care Facility, Mentally Retarded | 1846 Dayton Ave, Saint Paul, MN 55104-6012 | 2006-10-27 |
| 1568563898 | Our House of Minnesota, Inc. | Intermediate Care Facility, Mentally Retarded | 1846 Portland Ave, Saint Paul, MN 55104-6062 | 2006-09-26 |
| 1144326513 | Phoenix Residence, Inc. | Intermediate Care Facility, Mentally Retarded | 1500 Ames Ave, Saint Paul, MN 55106-7022 | 2006-09-15 |
| 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 |
| 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 |
| 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 |
| Find all providers with the same taxonomy | ||||
| City | SAINT PAUL |
| Zip Code | 55119 |
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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.