Provider Demographics
NPI:1891215604
Name:WHITE OAK RUN, LLC
Entity Type:Organization
Organization Name:WHITE OAK RUN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-557-7511
Mailing Address - Street 1:749 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 CHAMBERS CIRCLE RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:WV
Practice Address - Zip Code:26180-3585
Practice Address - Country:US
Practice Address - Phone:561-557-7511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder