Provider Demographics
NPI:1215527163
Name:BURWELL, ANTHONY W (OWNER)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:BURWELL
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:BURWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:864 WARWICK TPKE
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-1777
Mailing Address - Country:US
Mailing Address - Phone:973-207-8362
Mailing Address - Fax:
Practice Address - Street 1:19905 W CATAWBA AVE STE 201
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4037
Practice Address - Country:US
Practice Address - Phone:704-909-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3972253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care