Healthcare Provider Details

I. General information

NPI: 1821565946
Provider Name (Legal Business Name): THE WATERS SENIOR LIVING MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 07/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 FOWLER RD
WARRENDALE PA
15086-1126
US

IV. Provider business mailing address

10900 WAYZATA BLVD SUITE 740
MINNETONKA MN
55305-0004
US

V. Phone/Fax

Practice location:
  • Phone: 724-799-8260
  • Fax:
Mailing address:
  • Phone: 952-358-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: HEIDI M ELLIOTT
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 952-358-5100