Phoenix Service Corporation

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

1069741-1-HCBS Issued in MN

Legal business name

PHOENIX SERVICE CORPORATION

Practice address

330 Marie Ave E
West St Paul, MN 55118-4011

Phone

(651) 227-7655

Fax

(651) 227-6847

NPI assigned

May 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Darlene M Scott

Title

President/Ceo

Phone

(651) 227-7655

Specialties & licenses 4

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405555200000",
    "number": "1881645067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 MARIE AVE E",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "551184011",
            "telephone_number": "651-227-7655",
            "fax_number": "651-227-6847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 MARIE AVE E",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "551184011",
            "telephone_number": "651-227-7655",
            "fax_number": "651-227-6847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-13",
        "last_updated": "2014-07-17",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "651-227-7655"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MN",
            "license": "1069741-1-HCBS",
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "1069741-1-HCBS",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MN",
            "license": "1014199-1-WS",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "596555100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.