C10202017363071
Complete NPI Record 1134630734
Substance Abuse Rehabilitation Facility in Waverly, MN
Active since October 23, 2017
Complete NPI Dataset
This page contains the complete raw NPPES record for C10202017363071 (NPI 1134630734), a substance abuse rehabilitation facility organization in Waverly, MN. All 31 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1134630734 Field 1/31
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/31
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/31
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: C10202017363071 Field 4/31
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/31
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/31
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: C/O MERIDIAN BEHAVIORAL HEALTH #190 Field 7/31
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Second Line Business Mailing Address: 550 MAIN STREET Field 8/31
- The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
- Provider Business Mailing Address City Name: NEW BRIGHTON Field 9/31
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MN Field 10/31
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 55112 Field 11/31
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 12/31
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 6124542046 Field 13/31
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 109 N SHORE DR Field 14/31
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: WAVERLY Field 15/31
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MN Field 16/31
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 55390 Field 17/31
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/31
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 7636585800 Field 19/31
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 7636584128 Field 20/31
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: ZEIDNER Field 23/31
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: LEWIS Field 24/31
- The first name of the authorized official.
- Authorized Official Middle Name: P Field 25/31
- The middle name of the authorized official.
- Authorized Official Title or Position: CEO Field 26/31
- The title or position of the authorized official.
- Authorized Official Telephone Number: 7632458278 Field 27/31
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 324500000X Field 28/31
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 29/31
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 30/31
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Authorized Official Credential Text: PHD Field 31/31
- The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
EOSIS Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
Secondary Practice Locations 6
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
NEW BEGINNINGS MINNESOTA - ST PETER, 320 SUNRISE DRIVE; SUITE B
Location 1/6ST. PETER, MN 56082 · Phone (507) 931-0918 · Fax (763) 658-4128
NEW BEGINNINGS LITCHFIELD, 114 NORTH HOLCOMBE
Location 2/6LITCHFIELD, MN 55355 · Phone (320) 693-2461 · Fax (763) 658-4128
NEW BEGINNINGS WORTHINGTON, 1530 AIRPORT ROAD; SUITE 200
Location 3/6WORTHINGTON, MN 56187 · Phone (507) 376-3916 · Fax (763) 658-4128
7300 Estes Ave SW
Location 4/6Waverly, MN 55390-8432 · Phone (763) 658-5800 · Fax (763) 658-4128
105 S 5th St
Location 5/6Olivia, MN 56277-1374 · Phone (612) 590-7988 · Fax (763) 658-4128
NEW BEGINNINGS ELK RIVER, 19230 EVANS ST. Ste. 203
Location 6/6ELK RIVER, MN 55330 · Phone (763) 658-5800 · Fax (763) 658-4128
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