Organization
WAVERLEY - CASA DE PAZ, INC.
Active
Other names
Casa de Paz Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAUNCEY R. DUNBAR CPA (SECRETARY / TREASURER)
(601) 956-1576
Entity
Organization
Contact information
Practice address
2121 W 19TH ST, SIOUX CITY, IA 51103-2333
(712) 233-3127
(712) 233-1177
Mailing address
2121 W 19TH ST, SIOUX CITY, IA 51103-2333
(712) 233-3127
(712) 258-1177
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
970125
IA
332B00000X
Durable Medical Equipment & Medical Supplies
0474718
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0474718
DME
IA
01
—
0609950001
PART B SUPPLIER NUMBER
IA
05
—
0806919
—
IA
Enumeration date
09/08/2005
Last updated
09/16/2008
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