Organization
PWA & SPENCER HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOLBY RUTHERFORD (VP OF FINANCE & CONTROLLER)
(260) 702-3640
Entity
Organization
Contact information
Practice address
27 PEQUIGNOT DR, PIERCETON, IN 46562-9081
(260) 702-3752
(866) 681-7794
Mailing address
4150 ILLINOIS RD, FORT WAYNE, IN 46804-1208
(260) 702-3640
(866) 681-7794
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/25/2021
Last updated
07/19/2024
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