Healthcare Provider Details

I. General information

NPI: 1790185247
Provider Name (Legal Business Name): EWH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23010 HIGHWAY 5
WEST BLOCTON AL
35184-2672
US

IV. Provider business mailing address

23010 HIGHWAY 5
WEST BLOCTON AL
35184-2672
US

V. Phone/Fax

Practice location:
  • Phone: 310-500-8755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOK HITCHCOCK
Title or Position: OWNER
Credential:
Phone: 310-500-8755