Provider Demographics
NPI:1871069252
Name:WINGS OF AN ANGEL
Entity type:Organization
Organization Name:WINGS OF AN ANGEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-282-0158
Mailing Address - Street 1:6420 MOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121
Mailing Address - Country:US
Mailing Address - Phone:314-485-9602
Mailing Address - Fax:314-282-0158
Practice Address - Street 1:6420 MOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-5717
Practice Address - Country:US
Practice Address - Phone:314-458-9602
Practice Address - Fax:314-282-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health