Provider Demographics
NPI:1023298494
Name:WHIPPLE'S GROUP HOME, INC.
Entity type:Organization
Organization Name:WHIPPLE'S GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-575-1749
Mailing Address - Street 1:3134 PERIWINKLE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3077
Mailing Address - Country:US
Mailing Address - Phone:704-598-5051
Mailing Address - Fax:866-861-2334
Practice Address - Street 1:3134 PERIWINKLE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3077
Practice Address - Country:US
Practice Address - Phone:704-598-5051
Practice Address - Fax:866-861-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-1040320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities