Basic Information
Provider Information
NPI: 1245566967
EntityType: 2
ReplacementNPI:  
OrganizationName: WHISPERING PINES HOME CARE, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: RED RIVER HOMECARE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 51266
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705051266
CountryCode: US
TelephoneNumber: 3372331307
FaxNumber: 3372335764
Practice Location
Address1: 502 HIGHWAY 271 N
Address2:  
City: ANTLERS
State: OK
PostalCode: 745232014
CountryCode: US
TelephoneNumber: 5802985320
FaxNumber: 5802985326
Other Information
ProviderEnumerationDate: 10/30/2009
LastUpdateDate: 10/30/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: NOVEMBER
AuthorizedOfficialFirstName: PETER
AuthorizedOfficialMiddleName: C.
AuthorizedOfficialTitleorPosition: EXECUTIVE VICE PRESIDENT
AuthorizedOfficialTelephone: 3372331307
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix: II
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000X  Y AgenciesHome Health 

No ID Information.


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