Healthcare Provider Details

I. General information

NPI: 1629513882
Provider Name (Legal Business Name): WABASSO OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 MAPLE ST
WABASSO MN
56293-1614
US

IV. Provider business mailing address

660 MAPLE ST
WABASSO MN
56293-1614
US

V. Phone/Fax

Practice location:
  • Phone: 507-342-5166
  • Fax: 507-342-5136
Mailing address:
  • Phone: 507-342-5166
  • Fax: 507-342-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. EPHRAM LAHASKY
Title or Position: PRESIDENT
Credential:
Phone: 646-772-3668