Healthcare Provider Details

I. General information

NPI: 1851102933
Provider Name (Legal Business Name): IWACU INTERNATIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 N MARTIN LUTHER KING JR BLVD
LANSING MI
48915-2221
US

IV. Provider business mailing address

3500 S CEDAR ST STE 105A
LANSING MI
48910-4684
US

V. Phone/Fax

Practice location:
  • Phone: 517-402-1891
  • Fax:
Mailing address:
  • Phone: 517-402-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JC ABAYISENGA
Title or Position: DIRECTOR OF OPERATION
Credential:
Phone: 616-334-2141