Basic Information
| Provider Information | |||||||||
| NPI: | 1386155901 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW BEGINNINGS WAVERLY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | C/O MERIDIAN BEHAVIORAL HEALTH | ||||||||
| Address2: | 550 MAIN STREET | ||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123267600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 N SHORE DR | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553905517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7636585800 | ||||||||
| FaxNumber: | 7636584128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9522127168 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.