Provider Demographics
NPI:1093498388
Name:WINGS FOR LIFE INTERNATIONAL
Entity Type:Organization
Organization Name:WINGS FOR LIFE INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-389-7129
Mailing Address - Street 1:2015 WYOMING BLVD NE STE J
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2646
Mailing Address - Country:US
Mailing Address - Phone:505-226-4359
Mailing Address - Fax:
Practice Address - Street 1:2015 WYOMING BLVD NE STE J
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2646
Practice Address - Country:US
Practice Address - Phone:505-226-4359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health