1316158983 NPI number — A.W. HOLDINGS, LLC

Table of content: (NPI 1316158983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316158983 NPI number — A.W. HOLDINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A.W. HOLDINGS, 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:
6
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:
1316158983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8515 BLUFFTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46809-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-744-6145
Provider Business Mailing Address Fax Number:
260-444-0006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8515 BLUFFTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46809-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-744-6145
Provider Business Practice Location Address Fax Number:
260-444-0006
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEEBE
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
260-744-6145

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TM1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100244730 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200824450 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200833320 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200839230 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100229860 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100239820 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100244330 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100244500 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200460480 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200462800 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200889050 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200889890 A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100240120 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200453450 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200460460 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200474890 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200494750 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200842740 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 856345301 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100249000 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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