Provider Demographics
NPI:1528756947
Name:WHISPERING WILLOWS AT PALM BAY LLC
Entity type:Organization
Organization Name:WHISPERING WILLOWS AT PALM BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-543-8109
Mailing Address - Street 1:2838 AUDUBON VILLAGE DR UNIT 7124
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19407-1006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3604 JUPITER BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-3859
Practice Address - Country:US
Practice Address - Phone:321-327-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility