Provider Demographics
NPI:1679239008
Name:WAXDAHL ILS, LLC
Entity Type:Organization
Organization Name:WAXDAHL ILS, LLC
Other - Org Name:COMPLETE LIVING SOLUTIONS/INSIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-251-8763
Mailing Address - Street 1:4301 W 57TH ST STE 126
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2258
Mailing Address - Country:US
Mailing Address - Phone:605-251-8763
Mailing Address - Fax:605-271-0672
Practice Address - Street 1:4301 W 57TH ST STE 126
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2258
Practice Address - Country:US
Practice Address - Phone:605-251-8763
Practice Address - Fax:605-271-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care