Provider Demographics
NPI:1144983909
Name:WHITE DAISY HOMES, LLC
Entity type:Organization
Organization Name:WHITE DAISY HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:AMA
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:703-209-7073
Mailing Address - Street 1:23 STANLEY LOOP
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-8420
Mailing Address - Country:US
Mailing Address - Phone:703-209-7073
Mailing Address - Fax:
Practice Address - Street 1:23 STANLEY LOOP
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-8420
Practice Address - Country:US
Practice Address - Phone:703-209-7073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home