Provider Demographics
NPI:1275030793
Name:PWT NURSE CONSULTANTS & HOME SERVICES INC
Entity Type:Organization
Organization Name:PWT NURSE CONSULTANTS & HOME SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-925-7237
Mailing Address - Street 1:1746 E SILVER STAR RD STE 107
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7014
Mailing Address - Country:US
Mailing Address - Phone:407-925-7237
Mailing Address - Fax:
Practice Address - Street 1:7034 MINIPPI DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3345
Practice Address - Country:US
Practice Address - Phone:407-925-7237
Practice Address - Fax:407-925-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015366700Medicaid