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General NPI Number Information
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NPI Number | 1124785027
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Entity Type | Individual
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Provider Name | REBECCA SUE WHITMIRE
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Gender | Female
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 14708 PALMER AVENUE
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City | CLEARLAKE
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State | CA
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Zip | 95422-2945
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Country | US
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Telephone | 707-953-7064
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2945
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City | CLEARLAKE
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State | CA
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Zip | 95422-2945
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Country | US
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Telephone | 707-953-7064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R0166041
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License Number State | CA
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