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C10202017363071

Substance Abuse Rehabilitation Facility in Waverly, MN · enumerated 2017 · authorized official Lewis Zeidner, Ceo.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1134630734

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Registry record

Entity type Organization (Type 2)
Legal business name C10202017363071
Other name <Unavail>
Practice address 109 N Shore Dr, Waverly, MN, 55390
Phone (763) 658-5800
Fax (763) 658-4128
Enumeration date Oct 23, 2017
Last updated in NPPES Feb 21, 2025

Taxonomy & classification

324500000X Substance Abuse Rehabilitation Facility Residential Treatment Facilities Primary

Authorized official

Name Lewis Zeidner
Title Ceo
Phone (763) 245-8278

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Where is C10202017363071 located?
The practice location on file with NPPES is in Waverly, MN.
How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2025-02-21. Verify at npiregistry.cms.hhs.gov.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-02-21.