Organization
PHOENIX SERVICE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARLENE M SCOTT (PRESIDENT/CEO)
(651) 227-7655
Entity
Organization
Contact information
Practice address
330 MARIE AVE E, WEST ST PAUL, MN 55118-4011
(651) 227-7655
(651) 227-6847
Mailing address
330 MARIE AVE E, WEST ST PAUL, MN 55118-4011
(651) 227-7655
(651) 227-6847
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
1069741-1-HCBS
MN
251J00000X
Nursing Care Agency
—
MN
251S00000X
Community/Behavioral Health Agency
1069741-1-HCBS
MN
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
1014199-1-WS
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
596555100
—
MN
Enumeration date
05/13/2006
Last updated
07/17/2014
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