Provider Demographics
NPI:1144671744
Name:PASSWORD BMWD LLC
Entity type:Organization
Organization Name:PASSWORD BMWD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAGBODUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-230-7628
Mailing Address - Street 1:639 MICHIGAN BLVD APT 1500
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2670
Mailing Address - Country:US
Mailing Address - Phone:727-386-5195
Mailing Address - Fax:
Practice Address - Street 1:639 MICHIGAN BLVD APT 1500
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-2670
Practice Address - Country:US
Practice Address - Phone:727-386-5195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility