Waverley - Iowa, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

150366 Issued in IA

Legal business name

WAVERLEY - IOWA, INC.

Doing business as

Colonial Manor of Anita

Practice address

1000 Hillcrest Dr
Anita, IA 50020-1027

Phone

(712) 762-3219

NPI assigned

Nov 3, 2005

Last updated

Jul 24, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

WAVERLEY-IOWA, INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Chauncey R. Dunbar, CPA

Title

Secretary / Treasurer

Phone

(601) 956-1576

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Colonial Manor of Anita Doing business as

Part of

Waverley-Iowa Inc

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185235200000",
    "number": "1174514608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 HILLCREST DR",
            "city": "ANITA",
            "state": "IA",
            "postal_code": "500201027",
            "telephone_number": "712-762-3219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HILLCREST DR",
            "city": "ANITA",
            "state": "IA",
            "postal_code": "500201027",
            "telephone_number": "712-762-3219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLEY - IOWA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAVERLEY-IOWA, INC",
        "enumeration_date": "2005-11-03",
        "last_updated": "2007-07-24",
        "status": "A",
        "authorized_official_last_name": "DUNBAR",
        "authorized_official_first_name": "CHAUNCEY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "SECRETARY / TREASURER",
        "authorized_official_telephone_number": "601-956-1576",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": "150366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0807503",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Manor of Anita",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Anita, IA
• Providers in Anita, IA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.