Provider Demographics
NPI:1760965081
Name:W.P.R. LLC
Entity Type:Organization
Organization Name:W.P.R. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-276-8892
Mailing Address - Street 1:9919 MARQUAND DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3808
Mailing Address - Country:US
Mailing Address - Phone:206-201-9454
Mailing Address - Fax:
Practice Address - Street 1:2733 COUNTRY CLUB BLVD APT 87
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3975
Practice Address - Country:US
Practice Address - Phone:209-276-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility