Provider Demographics
NPI:1225565989
Name:ANGEL WINGS PERSONAL AND RESPITE CARE HOME
Entity Type:Organization
Organization Name:ANGEL WINGS PERSONAL AND RESPITE CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOKHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-324-3251
Mailing Address - Street 1:1011 PEARL RIVER AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-8646
Mailing Address - Country:US
Mailing Address - Phone:601-324-3251
Mailing Address - Fax:601-324-3251
Practice Address - Street 1:1011 PEARL RIVER AVENUE EXT
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-8646
Practice Address - Country:US
Practice Address - Phone:601-324-3251
Practice Address - Fax:601-324-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care