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 1649376005

Phoenix Residence, Inc is an Intellectual Disabilities Intermediate Care Facility in Mounds View, 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

7717 Long Lake Rd
Mounds View, MN 55112-6205
Phone: (763) 398-3812
Fax: (763) 398-3813
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual Disabilities Intermediate Care Facility (primary) Taxonomy 315P00000X · Licence 1032532 1 RS (MN)

Record details

NPI number1649376005
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Scott Darlene — 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

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