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General NPI Number Information
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NPI Number | 1255329918
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Entity Type | Organization
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Legal Business Name | WAVERLY HEIGHTS
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 1400 WAVERLY RD
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City | GLADWYNE
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State | PA
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Zip | 19035-1254
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Country | US
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Telephone | 610-645-8600
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Fax | 610-645-8611
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Provider Business Mailing Address
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Address Line | 1400 WAVERLY RD
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City | GLADWYNE
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State | PA
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Zip | 19035-1254
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Country | US
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Telephone | 610-645-8600
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Fax | 610-645-8611
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | THOMAS P GARVIN
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Credential |
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Telephone | 610-645-8607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | A45290
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 233402
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License Number State | PA
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