Provider Demographics
NPI:1689343089
Name:A.W. HOLDINGS, LLC
Entity Type:Organization
Organization Name:A.W. HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-207-5632
Mailing Address - Street 1:8515 BLUFFTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-3022
Mailing Address - Country:US
Mailing Address - Phone:260-744-6145
Mailing Address - Fax:
Practice Address - Street 1:2384 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-2964
Practice Address - Country:US
Practice Address - Phone:856-469-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0465526Medicaid