1386083160 NPI number — WAYZATA BAY SENIOR HOUSING, INC.

Table of content: (NPI 1386083160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386083160 NPI number — WAYZATA BAY SENIOR HOUSING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAYZATA BAY SENIOR HOUSING, INC.
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:
1386083160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2845 HAMLINE AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55113-7127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-631-6432
Provider Business Mailing Address Fax Number:
651-631-6122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PROMENADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYZATA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55391-4542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-249-2500
Provider Business Practice Location Address Fax Number:
952-249-2501
Provider Enumeration Date:
06/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TRANBY
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
651-631-6102

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NH1024 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com