Provider Demographics
NPI:1255815304
Name:WADLEY SNF OPERATOR LLC
Entity type:Organization
Organization Name:WADLEY SNF OPERATOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WERTHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-347-9888
Mailing Address - Street 1:10200 US HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:WADLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30477-3864
Mailing Address - Country:US
Mailing Address - Phone:478-252-5254
Mailing Address - Fax:478-252-1750
Practice Address - Street 1:10200 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:WADLEY
Practice Address - State:GA
Practice Address - Zip Code:30477-3864
Practice Address - Country:US
Practice Address - Phone:478-252-5254
Practice Address - Fax:478-252-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility