Organization
C10202017363071
Active
Other names
EOSIS
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIS P ZEIDNER PHD (CEO)
(763) 245-8278
Entity
Organization
Contact information
Practice address
109 N SHORE DR, WAVERLY, MN 55390
(763) 658-5800
(763) 658-4128
Mailing address
C/O MERIDIAN BEHAVIORAL HEALTH #190, 550 MAIN STREET, NEW BRIGHTON, MN 55112
(612) 454-2046
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/23/2017
Last updated
02/21/2025
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