MEDICARE: MSW LIVING 1 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1255854477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSW LIVING 1 LLC

Provider Business Mailing Address
First Line	:	PO BOX 903
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-0903
Country	:	US
Telephone Number	:	804-835-9568
Fax Number	:

Provider Business Practice Location Address
First Line	:	18506 TWISTED OAK TER
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-4602
Country	:	US
Telephone Number	:	804-835-9568
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY JONES
Credential	:
Telephone Number	:	804-835-9568

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/19/2017

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Directions to “MSW LIVING 1 LLC ” Practice Location

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