Provider Demographics
NPI:1255329918
Name:WAVERLY HEIGHTS
Entity type:Organization
Organization Name:WAVERLY HEIGHTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-645-8607
Mailing Address - Street 1:1400 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1254
Mailing Address - Country:US
Mailing Address - Phone:610-645-8600
Mailing Address - Fax:610-645-8611
Practice Address - Street 1:1400 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:GLADWYNE
Practice Address - State:PA
Practice Address - Zip Code:19035-1254
Practice Address - Country:US
Practice Address - Phone:610-645-8600
Practice Address - Fax:610-645-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAA45290310400000X
PA233402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6138OtherBC PROVIDER NUMBER
PA6138OtherBC PROVIDER NUMBER