Healthcare Provider Details

I. General information

NPI: 1306837125
Provider Name (Legal Business Name): WAVERLEY - CEDAR FALLS HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 W 8TH ST
CEDAR FALLS IA
50613-2002
US

IV. Provider business mailing address

1728 W 8TH ST
CEDAR FALLS IA
50613-2002
US

V. Phone/Fax

Practice location:
  • Phone: 319-277-2437
  • Fax:
Mailing address:
  • Phone: 319-277-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN-215
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0806927
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. CHAUNCEY R. DUNBAR
Title or Position: SECRETARY / TREASURER
Credential: CPA
Phone: 601-956-1576