Basic Information
| Provider Information | |||||||||
| NPI: | 1659337384 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WHISPERING PINES LODGE ILLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2131 ALPINE ROAD | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037578786 | ||||||||
| FaxNumber: | 9037538163 | ||||||||
| Practice Location | |||||||||
| Address1: | 2131 ALPINE ROAD | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037578786 | ||||||||
| FaxNumber: | 9037538163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JERGER | ||||||||
| AuthorizedOfficialFirstName: | SHERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9037578786 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 111432 | 01 | TX | LICENSE | OTHER |