Provider Demographics
NPI:1861656803
Name:WHISPERING OAKS RCF II, LLC
Entity Type:Organization
Organization Name:WHISPERING OAKS RCF II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:KEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-686-4490
Mailing Address - Street 1:203 N B ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5413
Mailing Address - Country:US
Mailing Address - Phone:576-686-4490
Mailing Address - Fax:573-686-8817
Practice Address - Street 1:203 N B ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5413
Practice Address - Country:US
Practice Address - Phone:573-686-4490
Practice Address - Fax:573-686-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033447310400000X
MO035142310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266745801Medicaid
MO1619147428OtherNPI
MO266768803Medicaid