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General NPI Number Information
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NPI Number | 1578865333
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Entity Type | Organization
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Legal Business Name | WAVERLY CARE HOME, LLC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 315 W BROAD ST
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City | WEST POINT
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State | MS
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Zip | 39773-2805
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Country | US
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Telephone | 662-494-0074
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Fax |
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Provider Business Mailing Address
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Address Line | 315 W BROAD ST
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City | WEST POINT
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State | MS
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Zip | 39773-2805
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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 | OWNER
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Name | ROBIN B FOSTER
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Credential |
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Telephone | 662-494-0074
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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 | 826
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License Number State | MS
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