Healthcare Provider Details

I. General information

NPI: 1376305680
Provider Name (Legal Business Name): LW SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 INGRAHAM ST NW
WASHINGTON DC
20011-3602
US

IV. Provider business mailing address

6218 GEORGIA AVE NW STE 1437
WASHINGTON DC
20011-5125
US

V. Phone/Fax

Practice location:
  • Phone: 202-460-6876
  • Fax: 202-559-5344
Mailing address:
  • Phone: 202-460-6876
  • Fax: 202-559-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 202-460-6876