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General NPI Number Information
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NPI Number | 1932413887
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Entity Type | Organization
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Legal Business Name | THE WAYSIDE HOUSE, INC.
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 2120 CLINTON AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-2649
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Country | US
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Telephone | 612-871-0099
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Fax | 612-871-0929
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Provider Business Mailing Address
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Address Line | 1600 UNIVERSITY AVE W STE 300
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City | SAINT PAUL
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State | MN
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Zip | 55104-3800
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Country | US
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Telephone | 651-242-5540
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Fax | 651-209-6341
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JENNIFER WILSON
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Credential |
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Telephone | 952-405-7649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1055132-1-CDT
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License Number State | MN
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