Provider Demographics
NPI:1851102933
Name:IWACU INTERNATIONAL CORP
Entity type:Organization
Organization Name:IWACU INTERNATIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:JC
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAYISENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-334-2141
Mailing Address - Street 1:3500 S CEDAR ST STE 105A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-4684
Mailing Address - Country:US
Mailing Address - Phone:517-402-1891
Mailing Address - Fax:
Practice Address - Street 1:1416 N MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-2221
Practice Address - Country:US
Practice Address - Phone:517-402-1891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253J00000XAgenciesFoster Care Agency
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)