Provider Demographics
NPI:1174017495
Name:WINGS OF AN ANGEL INC
Entity Type:Organization
Organization Name:WINGS OF AN ANGEL INC
Other - Org Name:WINGS OF AN ANGEL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENEZE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-985-0690
Mailing Address - Street 1:7957 ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3561
Mailing Address - Country:US
Mailing Address - Phone:786-985-0690
Mailing Address - Fax:754-888-9175
Practice Address - Street 1:3600 S STATE ROAD 7 STE 347
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-7203
Practice Address - Country:US
Practice Address - Phone:754-888-9074
Practice Address - Fax:754-888-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 253Z00000X, 374U00000X
FL24912372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101222400Medicaid
FL025122500Medicaid
FL101375000Medicaid
FL111194600Medicaid