Healthcare Provider Details

I. General information

NPI: 1255329918
Provider Name (Legal Business Name): WAVERLY HEIGHTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/20/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WAVERLY RD
GLADWYNE PA
19035-1254
US

IV. Provider business mailing address

1400 WAVERLY RD
GLADWYNE PA
19035-1254
US

V. Phone/Fax

Practice location:
  • Phone: 610-645-8600
  • Fax: 610-645-8611
Mailing address:
  • Phone: 610-645-8600
  • Fax: 610-645-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberA45290
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number233402
License Number StatePA

VIII. Authorized Official

Name: THOMAS P GARVIN
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 610-645-8607