Organization
WACONIA OPS. LLC
Active
Other names
Lighthouse at Waconia
Organization subpart
No
Provider details
NPI number
Authorized official
TINA DUVALL (CONTROLLER)
(952) 746-3630
Entity
Organization
Contact information
Practice address
500 S CHERRY ST, WACONIA, MN 55387-4515
(952) 442-1261
(952) 856-4711
Mailing address
500 S CHERRY ST, WACONIA, MN 55387-4515
(952) 442-1261
(952) 856-4711
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
448147000
MHCP ID
MN
Enumeration date
05/09/2007
Last updated
02/02/2010
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