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WILDWOOD GROVE
NPI 1184833394
Assisted Living Facility in Le Roy, MN

Active since May 22, 2007CLIA 24D1037844 · Waiver
410 E MAIN ST, LE ROY, MN 55951(507) 324-9515(507) 324-5355 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Wildwood Grove NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WILDWOOD GROVE (NPI 1184833394) is a healthcare organization registered as an assisted living facility in Le Roy, Minnesota and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through March 6, 2027 and lists Gerald A Payne, President Of Board, as its authorized official.

NPPES Registry Identity

NPI1184833394
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameWILDWOOD GROVE
Location Address410 E MAIN STLe Roy, MN 55951-6731
Mailing Address410 E Main StLe Roy, MN 55951-6731 · (507) 324-9515 · Fax (507) 324-5355
Phone(507) 324-9515
Fax(507) 324-5355
Organization SubpartNo
Authorized OfficialGerald A PaynePresident Of Board · (507) 324-5260
Enumeration DateMay 22, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1184833394 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in MN · 335745
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
410 E MAIN ST, Le Roy, MN 55951
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D1037844

Wildwood Grove · Le Roy, MN
Active · expires Mar 6, 2027
CLIA Number24D1037844
Laboratory TypeAssisted Living Facility
Certificate Effective DateMarch 7, 2025
Certificate Expiration DateMarch 6, 2027
Laboratory DirectorKari Mensink
Laboratory Phone(507) 324-9515
Laboratory LocationWildwood Grove410 East Main Street, Le Roy, MN 55951
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wildwood Grove's NPI number?

The NPI number for Wildwood Grove is 1184833394. It was assigned to this organization in the NPPES registry on May 22, 2007.

Where is Wildwood Grove located?

Wildwood Grove is located at 410 E Main St, Le Roy, MN 55951. The listed phone number is (507) 324-9515.

What is Wildwood Grove's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Wildwood Grove hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1037844) is associated with this NPI, valid through March 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wildwood Grove was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.