Provider Demographics
NPI:1083964837
Name:AUBURN MEADOWS, LLC
Entity Type:Organization
Organization Name:AUBURN MEADOWS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-0340
Mailing Address - Street 1:594 S CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4578
Mailing Address - Country:US
Mailing Address - Phone:952-442-2546
Mailing Address - Fax:952-442-5504
Practice Address - Street 1:591 S. CHERRY DR
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387
Practice Address - Country:US
Practice Address - Phone:952-442-6600
Practice Address - Fax:952-442-6605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORAVIAN CARE HOUSING CORP DBA AUBURN HOME IN WACONIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN358616310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN358616OtherLICENSE - HOUSING WITH SERVCIES