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WATERFORD MANOR
NPI 1356686836
Assisted Living Facility in Brooklyn Park, MN

Active since December 10, 2012CLIA 24D2048710 · Waiver
6288 LOUISIANA CT N, BROOKLYN PARK, MN 55428(763) 537-3382(763) 535-2075 Get Directions Write a Review

NPPES record last updated: April 27, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Waterford Manor NPPES

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

WATERFORD MANOR (NPI 1356686836) is a healthcare organization registered as an assisted living facility in Brooklyn Park, Minnesota and active in the NPI registry since December 2012. The organization holds a CLIA Waiver certificate valid through October 21, 2026 and lists Mark Mullen, Director Of Strategic Partnerships, as its authorized official.

NPPES Registry Identity

NPI1356686836
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameMINNESOTA SENIOR LIVING LLC
Location Address6288 LOUISIANA CT NBrooklyn Park, MN 55428-2550
Mailing Address915 118th Ave Se, 110Bellevue, WA 98005-3819 · (425) 559-6301 · Fax (425) 559-6302
Phone(763) 537-3382
Fax(763) 535-2075
Organization SubpartYesParent: Presbyterian Retirement Communities Northwest
Authorized OfficialMark MullenDirector Of Strategic Partnerships · (425) 559-6325
Enumeration DateDecember 10, 2012
Last NPPES UpdateApril 27, 2017
✔ NPI 1356686836 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
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.
6288 LOUISIANA CT N, Brooklyn Park, MN 55428
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Other Names 1

Doing Business AsWaterford Manor

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 24D2048710

Minnesota Senior Living LLC Dba Waterford Manor · Brooklyn Park, MN
Active · expires Oct 21, 2026
CLIA Number24D2048710
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 22, 2024
Certificate Expiration DateOctober 21, 2026
Laboratory DirectorThomasia Naya
Laboratory Phone(763) 316-4800
Laboratory LocationMinnesota Senior Living LLC Dba Waterford Manor6288 Louisana Court North, Brooklyn Park, MN 55428
CLIA data matches this NPI record on: Name
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 Minnesota Senior Living LLC's NPI number?

The NPI number for Minnesota Senior Living LLC is 1356686836. It was assigned to this organization in the NPPES registry on December 10, 2012. The provider is doing business as Waterford Manor.

Where is Minnesota Senior Living LLC located?

Minnesota Senior Living LLC is located at 6288 Louisiana Ct N, Brooklyn Park, MN 55428. The listed phone number is (763) 537-3382.

What is Minnesota Senior Living LLC's specialty?

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

Does Minnesota Senior Living LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2048710) is associated with this NPI, valid through October 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Minnesota Senior Living LLC was last updated on April 27, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.