Healthcare Provider Details

I. General information

NPI: 1528150174
Provider Name (Legal Business Name): WESTWOOD PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 JEFFERSON AVE SW
WATERTOWN MN
55388
US

IV. Provider business mailing address

209 JEFFERSON AVE SW
WATERTOWN MN
55388
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-1399
  • Fax: 952-955-1398
Mailing address:
  • Phone: 952-955-1399
  • Fax: 952-955-1398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number332948
License Number StateMN

VIII. Authorized Official

Name: DEANNE G BEITO
Title or Position: MANAGER
Credential:
Phone: 952-955-1399