Healthcare Provider Details

I. General information

NPI: 1891215604
Provider Name (Legal Business Name): WHITE OAK RUN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CHAMBERS CIRCLE RD
WALKER WV
26180-3585
US

IV. Provider business mailing address

749 US HIGHWAY 1
NORTH PALM BEACH FL
33408-4400
US

V. Phone/Fax

Practice location:
  • Phone: 561-557-7511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORIE MACOWSKI
Title or Position: VP FINANCE
Credential:
Phone: 561-557-7511