Provider Demographics
NPI:1740569979
Name:AW MINI SERVICE LLC
Entity Type:Organization
Organization Name:AW MINI SERVICE LLC
Other - Org Name:A&W MINI SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:480-430-0855
Mailing Address - Street 1:2556 N 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-2382
Mailing Address - Country:US
Mailing Address - Phone:602-278-2613
Mailing Address - Fax:602-278-2613
Practice Address - Street 1:2556 N 44TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-2382
Practice Address - Country:US
Practice Address - Phone:602-278-2613
Practice Address - Fax:602-278-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health