Provider Demographics
NPI:1891558284
Name:MWANZO ENTERPRISES LLC
Entity Type:Organization
Organization Name:MWANZO ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SAMMY
Authorized Official - Last Name:WAFULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-401-6223
Mailing Address - Street 1:131 JEFFORDS CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2842
Mailing Address - Country:US
Mailing Address - Phone:148-440-1622
Mailing Address - Fax:
Practice Address - Street 1:131 JEFFORDS CT
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2842
Practice Address - Country:US
Practice Address - Phone:148-440-1622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty