Provider Demographics
NPI:1033633904
Name:HADC WADENA, LLC
Entity Type:Organization
Organization Name:HADC WADENA, LLC
Other - Org Name:THE MEADOWS OF WADENA SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABZUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-473-1103
Mailing Address - Street 1:18336 MINNETONKA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3232
Mailing Address - Country:US
Mailing Address - Phone:952-473-1103
Mailing Address - Fax:952-473-1103
Practice Address - Street 1:110 HEMLOCK AVE. NW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482
Practice Address - Country:US
Practice Address - Phone:218-639-5290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN382221310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility