Provider Demographics
NPI:1306837125
Name:WAVERLEY - CEDAR FALLS HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:WAVERLEY - CEDAR FALLS HEALTH CARE CENTER, INC.
Other - Org Name:CEDAR FALLS HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAUNCEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:601-956-1576
Mailing Address - Street 1:1728 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2002
Mailing Address - Country:US
Mailing Address - Phone:319-277-2437
Mailing Address - Fax:
Practice Address - Street 1:1728 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2002
Practice Address - Country:US
Practice Address - Phone:319-277-2437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN-215314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0806927Medicaid
165197Medicare Oscar/Certification