=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750830485
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUIET WHISPER ASSITED LIVING FACILITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2016
-----------------------------------------------------
Last Update Date | 09/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 SW DEREK GLN
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32024-3770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-292-4552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 SW DEREK GLN
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32024-3770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-292-4552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CECILIA DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 386-292-4552
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | 12673
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 12673
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------