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General NPI Number Information
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NPI Number | 1033633904
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Entity Type | Organization
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Legal Business Name | HADC WADENA, LLC
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 110 HEMLOCK AVE. NW
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City | WADENA
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State | MN
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Zip | 56482
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Country | US
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Telephone | 218-639-5290
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Fax |
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Provider Business Mailing Address
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Address Line | 18336 MINNETONKA BLVD STE C
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City | WAYZATA
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State | MN
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Zip | 55391-3232
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Country | US
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Telephone | 952-473-1103
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Fax | 952-473-1103
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Authorized Official
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Title or Position | PRESIDENT/CHIEF MANAGER
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Name | PAUL ABZUG
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Credential |
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Telephone | 952-473-1103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 382221
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License Number State | MN
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