Provider Demographics
NPI:1073260329
Name:ANGEL WINGS HOME CARE LLC
Entity Type:Organization
Organization Name:ANGEL WINGS HOME CARE LLC
Other - Org Name:ANGEL WINGS HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-772-2266
Mailing Address - Street 1:1100 MERIDIAN BAY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1625
Mailing Address - Country:US
Mailing Address - Phone:702-772-2266
Mailing Address - Fax:
Practice Address - Street 1:1100 MERIDIAN BAY DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1625
Practice Address - Country:US
Practice Address - Phone:702-772-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty