Healthcare Provider Details

I. General information

NPI: 1659337384
Provider Name (Legal Business Name): WHISPERING PINES LODGE ILLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 ALPINE ROAD
LONGVIEW TX
75601
US

IV. Provider business mailing address

2131 ALPINE ROAD
LONGVIEW TX
75601
US

V. Phone/Fax

Practice location:
  • Phone: 903-757-8786
  • Fax: 903-753-8163
Mailing address:
  • Phone: 903-757-8786
  • Fax: 903-753-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHERRY JERGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-757-8786