Provider Demographics
NPI:1235963190
Name:HOUSE OF SDW ENTERPRISES
Entity type:Organization
Organization Name:HOUSE OF SDW ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-983-2676
Mailing Address - Street 1:400 ESPLANADE APT 61
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1420
Mailing Address - Country:US
Mailing Address - Phone:201-983-2676
Mailing Address - Fax:
Practice Address - Street 1:400 ESPLANADE APT 61
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1420
Practice Address - Country:US
Practice Address - Phone:201-983-2676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF SDW ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-31
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage