Provider Demographics
NPI:1972099240
Name:NEW BEGINNINGS WAVERLY LLC
Entity Type:Organization
Organization Name:NEW BEGINNINGS WAVERLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING, CREDENTIAL
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ASPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-454-2046
Mailing Address - Street 1:550 MAIN ST STE 190
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3271
Mailing Address - Country:US
Mailing Address - Phone:612-454-2046
Mailing Address - Fax:
Practice Address - Street 1:7300 ESTES AVE SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:MN
Practice Address - Zip Code:55390-8432
Practice Address - Country:US
Practice Address - Phone:763-658-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1089815-3-SUDX324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility