| New Beginnings At Waverly, Llc | |
|
109 N Shore Dr Waverly MN 55390-5517 | |
| (763) 658-5800 | |
| (763) 658-4128 |
| Full Name | New Beginnings At Waverly, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 109 N Shore Dr, Waverly, Minnesota |
| Authorized Official Name and Position | Clelland Pierre Gilchrist (CEO) |
| Authorized Official Contact | 7636585800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New Beginnings At Waverly, Llc 109 N Shore Dr Waverly MN 55390-5517 Ph: (763) 658-5800 | New Beginnings At Waverly, Llc 109 N Shore Dr Waverly MN 55390-5517 Ph: (763) 658-5800 |
| NPI Number | 1831413921 |
|---|---|
| Provider Enumeration Date | 03/18/2010 |
| Last Update Date | 03/18/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831413921 | NPI | - | NPPES |
| 1003743-5 CDT | Other | MN | MN DEPARTMENT OF HEALTH |
| 670005500 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1003743-5 CDT (Minnesota) | Primary |