Healthcare Provider Details

I. General information

NPI: 1902955396
Provider Name (Legal Business Name): DWI SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 FAIRGROUNDS ROAD
PRINCE FREDERICK MD
20678-0730
US

IV. Provider business mailing address

211 BOULEVARD OF THE AMERICAS SUITE 503
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-8930
  • Fax: 410-535-8935
Mailing address:
  • Phone: 732-967-2635
  • Fax: 410-535-8935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number905818
License Number StateMD

VIII. Authorized Official

Name: HUDI ALTER
Title or Position: CEO
Credential:
Phone: 732-967-2635