Provider Demographics
NPI:1811167372
Name:WHISPERING PINES INN LLC
Entity type:Organization
Organization Name:WHISPERING PINES INN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ARCHIBALD
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED RCFE ADMIN
Authorized Official - Phone:831-636-9620
Mailing Address - Street 1:476 LOS VIBORAS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-9465
Mailing Address - Country:US
Mailing Address - Phone:831-636-9620
Mailing Address - Fax:831-636-2903
Practice Address - Street 1:476 LOS VIBORAS RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-9465
Practice Address - Country:US
Practice Address - Phone:831-636-9620
Practice Address - Fax:831-636-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385H00000X385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care