MEDICARE: FWT HEALTHCARE AND PROFESSIONAL SERVICES, 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	251E00000X	Home Health Agency		NV

General Provider Information

NPI Number	:	1629365515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FWT HEALTHCARE AND PROFESSIONAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	340 E WARM SPRINGS RD
Second Line	:	SUITE15B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4257
Country	:	US
Telephone Number	:	702-560-0743
Fax Number	:	206-339-7957

Provider Business Practice Location Address
First Line	:	340 E WARM SPRINGS RD
Second Line	:	SUITE15B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4257
Country	:	US
Telephone Number	:	702-560-0743
Fax Number	:	206-339-7957

Authorized Official
Title or Position	:	OWNER MANAGING MEMBER
Name	:	MR. RAMON TORRES JR.
Credential	:	RN
Telephone Number	:	702-560-0743

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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