Provider Demographics
NPI:1043448483
Name:LA WINGS HOME HEALTH CARE II INC
Entity Type:Organization
Organization Name:LA WINGS HOME HEALTH CARE II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-890-9060
Mailing Address - Street 1:8907 SAINT CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-4237
Mailing Address - Country:US
Mailing Address - Phone:314-890-9060
Mailing Address - Fax:314-890-9082
Practice Address - Street 1:8907 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4237
Practice Address - Country:US
Practice Address - Phone:314-890-9060
Practice Address - Fax:314-890-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00933247251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0009903Medicaid
MO374U00000XMedicaid