1518641802 NPI number — LW CARE LLC

Table of content: MICHAEL JACKSON M.A., N.C.C, (NPI 1639625833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518641802 NPI number — LW CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LW CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518641802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 W UNION HILLS DR STE 350
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85027-5187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 SANTA FE CT FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59808-1730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-247-6129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WELL
Authorized Official First Name:
LIVE
Authorized Official Middle Name:
Authorized Official Title or Position:
ENTITY
Authorized Official Telephone Number:
915-247-6129

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)