Organization
PHOENIX GROUP HOMES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WENDY JEAN SPARKS (ASSISTANT DIRECTOR)
(651) 230-0849
Entity
Organization
Contact information
Practice address
2371 HIGHWOOD AVE E, MAPLEWOOD, MN 55119-5801
(651) 773-1142
(651) 773-5894
Mailing address
1011 INTERLACHEN PKWY, WOODBURY, MN 55125-8852
(651) 230-0849
(651) 773-5894
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
1037126-2-DCFC
MN
Other
Enumeration date
05/08/2007
Last updated
08/22/2020
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