Provider Demographics
NPI:1235630369
Name:WAVERLY PLACE APARTMENTS, LP
Entity Type:Organization
Organization Name:WAVERLY PLACE APARTMENTS, LP
Other - Org Name:MENTAL HEALTH ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM AND OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-257-8816
Mailing Address - Street 1:2686 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3522
Mailing Address - Country:US
Mailing Address - Phone:650-368-3345
Mailing Address - Fax:510-879-0354
Practice Address - Street 1:105 WAVERLY PLACE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-368-3345
Practice Address - Fax:510-879-0354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH ASSOCIATION OF SAN MATEO COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management