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Organization
WAVERLY ASSISTED LIVING, LLC
Active
Organization
WAVERLY ASSISTED LIVING, LLC
Active
Other names
Wellness at Home in Albany
Organization subpart
No
Provider details
NPI number
Authorized official
KIM BISTRONG PT (ADMINISTRATOR)
(503) 610-2932
Entity
Organization
Contact information
Practice address
2853 SALEM AVE SE, ALBANY, OR 97321-4562
(503) 610-2932
Mailing address
2853 SALEM AVE SE STE A, ALBANY, OR 97321-4562
(971) 204-7207
(503) 303-7234
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
13-1530
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38D2131497
CLIA
OR
Enumeration date
03/02/2017
Last updated
08/06/2021
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