Provider Demographics
NPI:1457892168
Name:KWD ENTERPRISE INC
Entity Type:Organization
Organization Name:KWD ENTERPRISE INC
Other - Org Name:HOME CARE ASSISTANCE OF GREEN VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-625-2050
Mailing Address - Street 1:1325 W DUVAL MINE RD STE 119
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5293
Mailing Address - Country:US
Mailing Address - Phone:520-625-2050
Mailing Address - Fax:
Practice Address - Street 1:1325 W DUVAL MINE RD STE 119
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5293
Practice Address - Country:US
Practice Address - Phone:520-625-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-18-03755253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care