Provider Demographics
NPI:1891109864
Name:TGWC ASSOCIATES LLC
Entity Type:Organization
Organization Name:TGWC ASSOCIATES LLC
Other - Org Name:THE GARDENS WELLNESS CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-675-0009
Mailing Address - Street 1:16565 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3511
Mailing Address - Country:US
Mailing Address - Phone:786-457-7014
Mailing Address - Fax:
Practice Address - Street 1:16565 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3511
Practice Address - Country:US
Practice Address - Phone:786-457-7014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility