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General NPI Number Information
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NPI Number | 1760965081
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Entity Type | Organization
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Legal Business Name | W.P.R. LLC
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/26/2020
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Provider Practice Location Address
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Address Line | 2733 COUNTRY CLUB BLVD APT 87
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City | STOCKTON
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State | CA
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Zip | 95204-3975
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Country | US
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Telephone | 209-276-8892
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Fax |
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Provider Business Mailing Address
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Address Line | 9919 MARQUAND DR
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City | BURKE
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State | VA
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Zip | 22015-3808
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Country | US
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Telephone | 206-201-9454
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW JOHNSON
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Credential |
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Telephone | 209-276-8892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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