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NPI Code Detail

MEDICARE: THE WATERVIEW PINES LLC

MEDICARE: THE WATERVIEW PINES 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1982269775
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE WATERVIEW PINES 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 : 1201 8TH ST S
Second Line :
City : VIRGINIA
State : MN
Zip : 55792-3349
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 PINES LLC ” Practice Location

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