Provider Demographics
NPI:1356537377
Name:AZLEWAY INC.
Entity type:Organization
Organization Name:AZLEWAY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-566-8444
Mailing Address - Street 1:15892 COUNTY ROAD 26
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-2728
Mailing Address - Country:US
Mailing Address - Phone:903-566-8444
Mailing Address - Fax:903-566-7696
Practice Address - Street 1:15892 COUNTY ROAD 26
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-2728
Practice Address - Country:US
Practice Address - Phone:903-566-8444
Practice Address - Fax:903-566-7696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX622680-01251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108347902Medicaid
TX108347901Medicaid