Healthcare Provider Details

I. General information

NPI: 1164878146
Provider Name (Legal Business Name): T & W ENTERPRISES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 TARA EST
LONDON KY
40744-9185
US

IV. Provider business mailing address

70 TARA EST
LONDON KY
40744-9185
US

V. Phone/Fax

Practice location:
  • Phone: 606-657-5055
  • Fax:
Mailing address:
  • Phone: 606-657-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRUCE WAYNE GENTRY
Title or Position: DIRECTOR
Credential:
Phone: 507-430-0430