Phoenix Residence, Inc.
Phoenix Residence, Inc. is a healthcare organization registered as Intellectual Disabilities Intermediate Care Facility in Mounds View, MN, holding Type 2 (organization) NPI 1649376005 since 2006. The authorized official on file is Scott Darlene, President/Ceo.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1649376005 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Phoenix Residence, Inc. |
| Practice address | 7717 LONG LAKE RD, Mounds View, MN, 55112 |
| Phone | 7633983812 |
| Fax | 7633983813 |
| Enumeration date | 2006-09-15 |
| Last updated in NPPES | 2008-07-01 |
Authorized official
| Name | Scott Darlene |
|---|---|
| Title | President/Ceo |
| Phone | 6512277655 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | Primary | 1032532 1 RS | MN |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 355474100 | Medicaid | MN | — |
Copy-ready billing details
Provider: Phoenix Residence, Inc. NPI: 1649376005 Taxonomy: 315P00000X (Intellectual Disabilities Intermediate Care Facility) Address: 7717 LONG LAKE RD, Mounds View, MN, 55112
Verify this record
Cross-check NPI 1649376005 against the authoritative CMS record: view Phoenix Residence, Inc. on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
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Where is Phoenix Residence, Inc. located?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2008-07-01.