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)
(971) 280-0677
Entity
Organization
Contact information
Practice address
2853 SALEM AVE SE STE A, ALBANY, OR 97321
(541) 650-6200
(541) 981-2211
Mailing address
2853 SALEM AVE SE STE A, ALBANY, OR 97321
(541) 650-6200
(541) 981-2211
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38-7165
AGENCY LICENSE
OR
05
—
500757550
—
OR
Enumeration date
11/28/2018
Last updated
08/09/2021
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