Healthcare Provider Details

I. General information

NPI: 1730145822
Provider Name (Legal Business Name): WAVERLY HEALTH CARE AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 POWERS BLVD
WAVERLY TN
37185
US

IV. Provider business mailing address

P.O, BOX 10
PARSONS TN
38363-0010
US

V. Phone/Fax

Practice location:
  • Phone: 931-296-7552
  • Fax: 931-296-1209
Mailing address:
  • Phone: 731-847-6343
  • Fax: 731-847-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0134
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0134
License Number StateTN

VIII. Authorized Official

Name: MS. ROBIN F BRADLEY
Title or Position: SECRETARY
Credential:
Phone: 615-595-8383