Healthcare Provider Details

I. General information

NPI: 1144360512
Provider Name (Legal Business Name): WHISPERING WATERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/14/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11596 W PURDUE AVE
YOUNGTOWN AZ
85363-1732
US

IV. Provider business mailing address

11596 W PURDUE AVE
YOUNGTOWN AZ
85363-1732
US

V. Phone/Fax

Practice location:
  • Phone: 623-388-4647
  • Fax: 623-266-9680
Mailing address:
  • Phone: 623-388-4647
  • Fax: 623-266-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberALH5220
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: LASHANNA D ROE
Title or Position: OWNER
Credential:
Phone: 623-570-1521