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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