Provider Demographics
NPI:1235722893
Name:WINGS OF AN ANGEL INC
Entity Type:Organization
Organization Name:WINGS OF AN ANGEL INC
Other - Org Name:
Other - Org Type:
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 1:15098 72ND CIR
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3347
Practice Address - Country:US
Practice Address - Phone:786-985-0690
Practice Address - Fax:754-888-9175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WINGS OF AN ANGEL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty