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General NPI Number Information
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NPI Number | 1588134985
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Entity Type | Organization
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Legal Business Name | WHISPERING OAKS LODGE
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 910 PIERREMONT RD STE 103
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City | SHREVEPORT
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State | LA
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Zip | 71106-2058
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Country | US
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Telephone | 877-419-3005
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Fax | 877-419-0358
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Provider Business Mailing Address
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Address Line | 617 PIAT RD
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-6438
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Country | US
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Telephone | 318-366-8596
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DARREN DAVIS
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Credential | R. PH.
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Telephone | 318-366-8596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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