Provider Demographics
NPI:1588134985
Name:WHISPERING OAKS LODGE
Entity type:Organization
Organization Name:WHISPERING OAKS LODGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:318-366-8596
Mailing Address - Street 1:617 PIAT RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6438
Mailing Address - Country:US
Mailing Address - Phone:318-366-8596
Mailing Address - Fax:
Practice Address - Street 1:910 PIERREMONT RD STE 103
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2058
Practice Address - Country:US
Practice Address - Phone:877-419-3005
Practice Address - Fax:877-419-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility