Provider Demographics
NPI:1528454246
Name:CWM TRUST, LLC
Entity type:Organization
Organization Name:CWM TRUST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC JOSEPH
Authorized Official - Middle Name:BERNAL
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:670-989-6000
Mailing Address - Street 1:P.O. BOX 500087, CK
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0087
Mailing Address - Country:US
Mailing Address - Phone:670-233-3647
Mailing Address - Fax:
Practice Address - Street 1:6 GUALO RAI PLAZA, CHALAN PALE ARNOLD RD
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-3647
Practice Address - Country:US
Practice Address - Phone:670-233-3647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MPR14185251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health