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General NPI Number Information
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NPI Number | 1548820798
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Entity Type | Organization
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Legal Business Name | ALW ENTERPRISES, PA
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1001 COLLEGE BLVD W STE B1
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City | NICEVILLE
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State | FL
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Zip | 32578-1049
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Country | US
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Telephone | 850-252-4303
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Fax | 833-963-2101
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Provider Business Mailing Address
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Address Line | 1001 COLLEGE BLVD W STE B1
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City | NICEVILLE
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State | FL
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Zip | 32578-1049
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Country | US
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Telephone | 850-252-4303
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Fax | 833-963-2101
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. VIRGINIA HAUSER
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Credential |
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Telephone | 850-252-4303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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