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General NPI Number Information
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NPI Number | 1417611880
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Entity Type | Organization
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Legal Business Name | WAVERLY OPERATING LLC
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 456 E MAIN ST
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City | WAVERLY
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State | VA
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Zip | 23890-3237
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Country | US
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Telephone | 804-834-3975
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Fax |
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Provider Business Mailing Address
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Address Line | 311 BLVD OF THE AMERICAS STE 504
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City | LAKEWOOD
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State | NJ
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Zip | 08701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TZVI ALTER
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Credential |
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Telephone | 732-719-7270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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