Provider Demographics
NPI:1891114963
Name:LAKE WHITNEY OPERATIONS, LLC
Entity Type:Organization
Organization Name:LAKE WHITNEY OPERATIONS, LLC
Other - Org Name:FAMILY HOME HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WILLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-581-1223
Mailing Address - Street 1:PO BOX 130010
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0010
Mailing Address - Country:US
Mailing Address - Phone:903-581-1223
Mailing Address - Fax:903-581-1253
Practice Address - Street 1:108 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2623
Practice Address - Country:US
Practice Address - Phone:254-694-1447
Practice Address - Fax:254-694-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health