MEDICARE: THE WATERVIEW WOODS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1598320368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WATERVIEW WOODS LLC

Provider Business Mailing Address
First Line	:	638 SOUTHBEND AVE
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-2168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 GRANT AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1314
Country	:	US
Telephone Number	:	218-748-7800
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOSH LEGUM
Credential	:
Telephone Number	:	507-203-1001

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	06/18/2019

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Directions to “THE WATERVIEW WOODS LLC ” Practice Location

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