Provider Demographics
NPI:1821252594
Name:AW HOLDINGS OF NEW MEXICO LLC
Entity Type:Organization
Organization Name:AW HOLDINGS OF NEW MEXICO LLC
Other - Org Name:AWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:260-744-6145
Mailing Address - Street 1:2008 SAINT MICHAELS DR
Mailing Address - Street 2:BLDG C-21
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7682
Mailing Address - Country:US
Mailing Address - Phone:260-744-6145
Mailing Address - Fax:260-444-0006
Practice Address - Street 1:8515 BLUFFTON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-3022
Practice Address - Country:US
Practice Address - Phone:260-744-6145
Practice Address - Fax:260-444-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services