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General NPI Number Information
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NPI Number | 1548139751
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Entity Type | Organization
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Legal Business Name | WAVERLY SENIOR LIVING LLC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 105 PLUM RUN
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City | LE SUEUR
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State | MN
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Zip | 56058-2188
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Country | US
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Telephone | 847-370-6328
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Fax |
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Provider Business Mailing Address
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Address Line | 105 PLUM RUN
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City | LE SUEUR
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State | MN
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Zip | 56058-2188
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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 | MANAGER
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Name | RONAK PATEL
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Credential |
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Telephone | 847-370-6328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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