Provider Demographics
NPI:1972077360
Name:A.W. HOLDINGS, LLC
Entity Type:Organization
Organization Name:A.W. HOLDINGS, LLC
Other - Org Name:BENCHMARK HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOBAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-207-5604
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 1:3240 1ST AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3209
Practice Address - Country:US
Practice Address - Phone:605-644-7370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251X00000XAgenciesSupports BrokerageGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2012051Medicaid