Basic Information
| Provider Information | |||||||||
| NPI: | 1417611880 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAVERLY OPERATING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 BLVD OF THE AMERICAS | ||||||||
| Address2: | STE 504 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08701 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 456 E MAIN ST | ||||||||
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| City: | WAVERLY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238903237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048343975 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2021 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | ALTER | ||||||||
| AuthorizedOfficialFirstName: | TZVI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7327197270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.