| Organization Name: | PHOENIX SERVICE CORPORATION |
| NPI Number: | 1881645067 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DARLENE M SCOTT (PRESIDENT/CEO) |
| Mailing Address: | 330 Marie Ave E West St Paul |
| State: | MN US |
| Postal Code: | 551184011 |
| Phone Number: | 6512277655 |
| Fax Number: | 6512276847 |
| NPI Enumeration Date: | 05/13/2006 |
| NPI Last Update Date: | 07/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320900000X |
| License Number: | 1014199-1-WS |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |