Healthcare Provider Details

I. General information

NPI: 1336799469
Provider Name (Legal Business Name): A.W. HOLDINGS OF MARYLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 BALTIMORE BLVD STE 210
WESTMINSTER MD
21157-6128
US

IV. Provider business mailing address

8515 BLUFFTON RD
FORT WAYNE IN
46809-3022
US

V. Phone/Fax

Practice location:
  • Phone: 443-426-2008
  • Fax:
Mailing address:
  • Phone: 260-207-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JORDAN WARD
Title or Position: PARALEGAL
Credential:
Phone: 260-207-5730