Provider Demographics
NPI:1003091521
Name:WW HEALTHCARE LLC
Entity Type:Organization
Organization Name:WW HEALTHCARE LLC
Other - Org Name:PRINCETON PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-255-1514
Mailing Address - Street 1:500 LOUISIANA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2051
Mailing Address - Country:US
Mailing Address - Phone:505-255-1717
Mailing Address - Fax:
Practice Address - Street 1:500 LOUISIANA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2051
Practice Address - Country:US
Practice Address - Phone:505-255-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1077314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02983834Medicaid
NM325045Medicare Oscar/Certification