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General NPI Number Information
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NPI Number | 1891114963
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Entity Type | Organization
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Legal Business Name | LAKE WHITNEY OPERATIONS, LLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 108 S COLORADO ST
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City | WHITNEY
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State | TX
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Zip | 76692-2623
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Country | US
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Telephone | 254-694-1447
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Fax | 254-694-1425
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Provider Business Mailing Address
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Address Line | PO BOX 130010
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City | TYLER
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State | TX
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Zip | 75713-0010
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Country | US
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Telephone | 903-581-1223
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Fax | 903-581-1253
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL ROBERT WILLSON
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Credential |
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Telephone | 903-581-1223
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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 |
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License Number State |
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