Provider Demographics
NPI:1215796115
Name:AWJW1 LLC
Entity type:Organization
Organization Name:AWJW1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:484-965-9529
Mailing Address - Street 1:1000 GERMANTOWN PIKE STE E1
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2485
Mailing Address - Country:US
Mailing Address - Phone:484-965-9529
Mailing Address - Fax:
Practice Address - Street 1:100 S BROAD ST STE 2230
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1021
Practice Address - Country:US
Practice Address - Phone:484-965-9529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNKNOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health