Provider Demographics
NPI:1073835963
Name:ON WINGS LIKE EAGLES, LLC
Entity Type:Organization
Organization Name:ON WINGS LIKE EAGLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:KRUIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LADAC
Authorized Official - Phone:575-650-0071
Mailing Address - Street 1:1801 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4956
Mailing Address - Country:US
Mailing Address - Phone:575-522-1422
Mailing Address - Fax:575-532-5175
Practice Address - Street 1:1435 PECOS ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4335
Practice Address - Country:US
Practice Address - Phone:575-522-1422
Practice Address - Fax:575-532-5175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-130243-00-2251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health