Provider Demographics
NPI:1497407522
Name:IBWII GROUP LLC
Entity Type:Organization
Organization Name:IBWII GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSILESI
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:571-732-6800
Mailing Address - Street 1:22648 GLENN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164
Mailing Address - Country:US
Mailing Address - Phone:571-732-6800
Mailing Address - Fax:
Practice Address - Street 1:22648 GLENN DR
Practice Address - Street 2:SUITE 304
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-2016
Practice Address - Country:US
Practice Address - Phone:571-732-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care