Healthcare Provider Details

I. General information

NPI: 1750830485
Provider Name (Legal Business Name): QUIET WHISPER ASSITED LIVING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 SW DEREK GLN
LAKE CITY FL
32024-3770
US

IV. Provider business mailing address

190 SW DEREK GLN
LAKE CITY FL
32024-3770
US

V. Phone/Fax

Practice location:
  • Phone: 386-292-4552
  • Fax:
Mailing address:
  • Phone: 386-292-4552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number12673
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number12673
License Number StateFL

VIII. Authorized Official

Name: CECILIA DAVIS
Title or Position: OWNER
Credential:
Phone: 386-292-4552