Provider Demographics
NPI:1669033072
Name:BCP WAVERLY, LLC
Entity Type:Organization
Organization Name:BCP WAVERLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-399-4918
Mailing Address - Street 1:702 S HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11041 N 137TH ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NE
Practice Address - Zip Code:68462-1022
Practice Address - Country:US
Practice Address - Phone:402-786-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility