Waters Edge at Willow Brook

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

366639 Issued in MN

Legal business name

WATERS EDGE AT WILLOW BROOK

Doing business as

Water's Edge

Practice address

800 Agency TRL
Mankato, MN 56001-6936

Phone

(507) 388-5582

NPI assigned

Apr 14, 2014

Organization subpart

No

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

Authorized official

Name

Brooke Amber Olson

Title

Director of Operations

Phone

(507) 388-5582

Specialties & licenses 1

Addresses

Other names 1

• Water's Edge Doing business as

Locations

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397433600000",
    "number": "1912326489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 WOODHILL CT",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014773",
            "telephone_number": "507-388-5582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 AGENCY TRL",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016936",
            "telephone_number": "507-388-5582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERS EDGE AT WILLOW BROOK",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-14",
        "last_updated": "2014-04-14",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "AMBER",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "507-388-5582"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "366639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Water's Edge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ming-Hsi Wang, M.D., PH.D.
• Shari Lynn Ward, LPN
• Elizabeth Jean Wargelin, OTR/L
• Mohamed Warsame, M.D
• Cori Lynn Wasz
• Waterville Chiropractice Center (Minnesota Institute of Wellness)
• Roxanne Ashley Watkins
• Isabella Watts
• We Care Home Care LLC
• Kara Katherine Weber, DDS

• Assisted Living Facility in Mankato, MN
• Providers in Mankato, 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 Apr 14, 2014; 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.