SHP V WSLG Plymouth LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SHP V WSLG PLYMOUTH LLC

Doing business as

The Waters of Plymouth

Practice address

11305 Highway 55
Plymouth, MN 55441-6035

Phone

(763) 270-5220

NPI assigned

Jun 22, 2021

Organization subpart

No

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

Authorized official

Name

Steven Blazejewski

Title

President

Phone

(404) 704-3789

Specialties & licenses 1

Addresses

Other names 1

• The Waters of Plymouth Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1538738778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3348 PEACHTREE RD NE STE 1100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303261447",
            "telephone_number": "404-704-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11305 HIGHWAY 55",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554416035",
            "telephone_number": "763-270-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHP V WSLG PLYMOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "BLAZEJEWSKI",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-704-3789"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Waters of Plymouth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Bradley Shinder, DC
• Jeff William Shively, LICSW
• Kari Shoemaker, M.S
• Emily Mae Shopek, LICSW
• Jeff Shorten, PHARMD
• SHS-MN, Inc (Seniors Helping Seniors)
• Rehan A Siddiqui, MD
• Avalon Sidney
• Robby Singh Sikka, M.D.
• Philip Simon, DPT

• Assisted Living Facility in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.