1104323773 NPI number — NEW WESTERN MANOR COMPANY LIMITED PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104323773 NPI number — NEW WESTERN MANOR COMPANY LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW WESTERN MANOR COMPANY LIMITED PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104323773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 HAZELTINE BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHASKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55318-1070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-618-1682
Provider Business Mailing Address Fax Number:
952-361-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3715 COON RAPIDS BLVD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COON RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-772-4492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WEICHERT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF GENERAL PARTNER
Authorized Official Telephone Number:
952-361-8000

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  381474 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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