Provider Demographics
NPI:1043508591
Name:ANGEL WINGS HOME SERVICES & CASE MANAGEMENT AGENCY, LLC
Entity Type:Organization
Organization Name:ANGEL WINGS HOME SERVICES & CASE MANAGEMENT AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-720-2026
Mailing Address - Street 1:517 C ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1251
Mailing Address - Country:US
Mailing Address - Phone:304-720-2026
Mailing Address - Fax:304-720-2027
Practice Address - Street 1:517 C ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1251
Practice Address - Country:US
Practice Address - Phone:304-720-2026
Practice Address - Fax:304-720-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2254-3593253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care