Waverley - Casa de Paz, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

970125 Issued in IA

Legal business name

WAVERLEY - CASA DE PAZ, INC.

Practice address

2121 W 19TH St
Sioux City, IA 51103-2333

Phone

(712) 233-3127

Fax

(712) 233-1177

NPI assigned

Sep 8, 2005

Organization subpart

No

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 2

Addresses

Other identifiers 3

Other names 1

• Casa de Paz Health Care Center Doing business as

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1770577405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 W 19TH ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511032333",
            "telephone_number": "712-233-3127",
            "fax_number": "712-258-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 W 19TH ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511032333",
            "telephone_number": "712-233-3127",
            "fax_number": "712-233-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLEY - CASA DE PAZ, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2008-09-16",
        "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": "970125",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IA",
            "license": "0474718",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0806919",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME",
            "identifier": "0474718",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B SUPPLIER NUMBER",
            "identifier": "0609950001",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Casa de Paz Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; 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.