Provider Demographics
NPI:1649963109
Name:WHITEMOUNTAIN LLC
Entity type:Organization
Organization Name:WHITEMOUNTAIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TITILOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-251-2366
Mailing Address - Street 1:7133 116TH PL N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2879
Mailing Address - Country:US
Mailing Address - Phone:612-483-3771
Mailing Address - Fax:
Practice Address - Street 1:7133 116TH PL N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2879
Practice Address - Country:US
Practice Address - Phone:612-483-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No385H00000XRespite Care FacilityRespite Care
No251S00000XAgenciesCommunity/Behavioral Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child