Provider Demographics
NPI:1073742599
Name:CWP HEALTHCARE OF EDGEWATER LLC
Entity Type:Organization
Organization Name:CWP HEALTHCARE OF EDGEWATER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-818-7500
Mailing Address - Street 1:5305 VILLAGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4810
Mailing Address - Country:US
Mailing Address - Phone:972-818-7500
Mailing Address - Fax:972-732-6644
Practice Address - Street 1:2228 SEAWALL BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-8940
Practice Address - Country:US
Practice Address - Phone:972-818-7500
Practice Address - Fax:972-732-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility