Provider Demographics
NPI:1295200293
Name:LWGG NURSYS CARE
Entity Type:Organization
Organization Name:LWGG NURSYS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LHENS
Authorized Official - Middle Name:F
Authorized Official - Last Name:JUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-259-6276
Mailing Address - Street 1:112 SPENCER ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4601
Mailing Address - Country:US
Mailing Address - Phone:617-259-6276
Mailing Address - Fax:
Practice Address - Street 1:112 SPENCER ST STE 1B
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4601
Practice Address - Country:US
Practice Address - Phone:617-259-6276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000000000000Medicaid