C10202017363071

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

C10202017363071

Practice address

109 N Shore Dr
Waverly, MN 55390

Phone

(763) 658-5800

Fax

(763) 658-4128

NPI assigned

Oct 23, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lewis P Zeidner, PHD

Title

Ceo

Phone

(763) 245-8278

Specialties & licenses 1

Addresses

Other names 1

• EOSIS Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ernest William Lampe, M.D.

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Minneapolis, MN
  • NPI 1023062783
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1134630734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O MERIDIAN BEHAVIORAL HEALTH #190",
            "address_2": "550 MAIN STREET",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "55112",
            "telephone_number": "612-454-2046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N SHORE DR",
            "city": "WAVERLY",
            "state": "MN",
            "postal_code": "55390",
            "telephone_number": "763-658-5800",
            "fax_number": "763-658-4128"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "NEW BEGINNINGS LITCHFIELD",
            "address_2": "114 NORTH HOLCOMBE",
            "address_purpose": "LOCATION",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "55355",
            "country_code": "US",
            "telephone_number": "320-693-2461",
            "fax_number": "763-658-4128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7300 Estes Ave SW",
            "address_purpose": "LOCATION",
            "city": "Waverly",
            "state": "MN",
            "postal_code": "553908432",
            "country_code": "US",
            "telephone_number": "763-658-5800",
            "fax_number": "763-658-4128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "NEW BEGINNINGS WORTHINGTON",
            "address_2": "1530 AIRPORT ROAD; SUITE 200",
            "address_purpose": "LOCATION",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "56187",
            "country_code": "US",
            "telephone_number": "507-376-3916",
            "fax_number": "763-658-4128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "NEW BEGINNINGS MINNESOTA - ST PETER",
            "address_2": "320 SUNRISE DRIVE; SUITE B",
            "address_purpose": "LOCATION",
            "city": "ST. PETER",
            "state": "MN",
            "postal_code": "56082",
            "country_code": "US",
            "telephone_number": "507-931-0918",
            "fax_number": "763-658-4128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 S 5th St",
            "address_purpose": "LOCATION",
            "city": "Olivia",
            "state": "MN",
            "postal_code": "562771374",
            "country_code": "US",
            "telephone_number": "612-590-7988",
            "fax_number": "763-658-4128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "NEW BEGINNINGS ELK RIVER",
            "address_2": "19230 EVANS ST. Ste. 203",
            "address_purpose": "LOCATION",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "55330",
            "country_code": "US",
            "telephone_number": "763-658-5800",
            "fax_number": "763-658-4128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "C10202017363071",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-23",
        "last_updated": "2025-02-21",
        "status": "A",
        "authorized_official_last_name": "ZEIDNER",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-245-8278",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EOSIS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Adjust to Wellness, PLLC
• Andrea Zitzloff
• Sarah Suzann Bartosch, D.C.
• Amanda Decker
• Early Bird Outcomes, Inc.
• Emf Webz LLC
• Cindy Grangroth
• Candace Latanya Hanson, M.A., LPCC

• All providers in Waverly, MN
• Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.