=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801198569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | W&D ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2010
-----------------------------------------------------
Last Update Date | 11/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 MARSHALL ST
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33755-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-442-9708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 MARSHALL ST
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33755-2641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-442-9708
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. WENDELL L. DUGGINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-442-9708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL11815
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------