Provider Demographics
NPI:1679864862
Name:HW3 MT LLC
Entity Type:Organization
Organization Name:HW3 MT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF HW3 HOUSING, INC. MANA
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-799-0322
Mailing Address - Street 1:11 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3221
Mailing Address - Country:US
Mailing Address - Phone:508-799-0322
Mailing Address - Fax:508-799-0322
Practice Address - Street 1:50 PINE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440
Practice Address - Country:US
Practice Address - Phone:978-632-8292
Practice Address - Fax:978-632-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility