Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Phoenix Residence, Inc

Organization Intellectual Disabilities Intermediate Care Facility · NPI 1376649673

Phoenix Residence, Inc is an Intellectual Disabilities Intermediate Care Facility in Little Canada, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

645 Viking Dr E
Little Canada, MN 55117-1663
Phone: (651) 294-2076
Fax: (651) 294-2077
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual Disabilities Intermediate Care Facility (primary) Taxonomy 315P00000X · Licence 1033704 1 RS (MN)

Record details

NPI number1376649673
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Darlene Scott — President/Ceo · (651) 227-7655
NPI enumeratedSeptember 15, 2006
Last updated in NPPESJuly 1, 2008
Mailing address330 Marie Ave E, West St Paul, MN 55118-4011