MEDICARE: DWCK, 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	253Z00000X	In Home Supportive Care Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1306103312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DWCK, LLC

Provider Business Mailing Address
First Line	:	4802 LAZY TIMBERS DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-4455
Country	:	US
Telephone Number	:	281-973-9273
Fax Number	:	866-447-8979

Provider Business Practice Location Address
First Line	:	4802 LAZY TIMBERS DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-4455
Country	:	US
Telephone Number	:	281-973-9273
Fax Number	:	866-447-8979

Authorized Official
Title or Position	:	MEMBER
Name	:	DONNA WEST
Credential	:
Telephone Number	:	281-973-9273

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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Directions to “DWCK, LLC ” Practice Location

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