Healthcare Provider Details

I. General information

NPI: 1851789234
Provider Name (Legal Business Name): LG'S WHISPERING PINES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69350 CHRISTIANA CREEK DR
EDWARDSBURG MI
49112-8731
US

IV. Provider business mailing address

69350 CHRISTIANA CREEK DR
EDWARDSBURG MI
49112-8731
US

V. Phone/Fax

Practice location:
  • Phone: 269-699-7482
  • Fax: 269-699-8117
Mailing address:
  • Phone: 269-699-7482
  • Fax: 269-699-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAF140093677
License Number StateMI

VIII. Authorized Official

Name: GABRIELE B JAMISON
Title or Position: OWNER
Credential:
Phone: 269-699-7482