=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962735241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HWE ENTERPRISES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2009
-----------------------------------------------------
Last Update Date | 09/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1643 WILLIAMSBURG SQ SUITE E
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-4279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-825-6008
-----------------------------------------------------
Fax | 863-825-6009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1643 WILLIAMSBURG SQ SUITE E
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-4279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-825-6008
-----------------------------------------------------
Fax | 863-825-6009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. HOWARD WARREN ELLIS JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-825-6008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 231207
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------