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NPI Code Detail

MEDICARE: PWP HEALTH, LLC

MEDICARE: PWP HEALTH, 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
1261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1538760798
Entity Type Code : Organization
Provider Name (Legal Business Name) : PWP HEALTH, LLC
Provider Business Mailing Address
First Line : 621 BROAD ST
Second Line :
City : ALTAVISTA
State : VA
Zip : 24517-1855
Country : US
Telephone Number : 434-608-2618
Fax Number :
Provider Business Practice Location Address
First Line : 2833 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-8470
Country : US
Telephone Number : 434-608-2618
Fax Number :
Authorized Official
Title or Position : OWNER
Name : YOLANDA STONE
Credential :
Telephone Number : 434-608-2618
Provider Enumeration Date : 11/04/2020
Last Update Date : 05/12/2021

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