Organization
NEW BEGINNINGS AT WAVERLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLELLAND PIERRE GILCHRIST MS LADC (CEO)
(763) 658-5800
Entity
Organization
Contact information
Practice address
109 N SHORE DR, WAVERLY, MN 55390-5517
(763) 658-5800
(763) 658-4128
Mailing address
109 N SHORE DR, WAVERLY, MN 55390-5517
(763) 658-5800
(763) 658-4128
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1003743-5 CDT
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003743-5 CDT
MN DEPARTMENT OF HEALTH
MN
05
—
670005500
—
MN
Enumeration date
03/18/2010
Last updated
03/18/2010
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