Provider Demographics
NPI:1245601442
Name:ANGEL WINGS HEALTHCARE LLC
Entity Type:Organization
Organization Name:ANGEL WINGS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHEA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-583-6636
Mailing Address - Street 1:1201 N WATSON RD STE 187
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6225
Mailing Address - Country:US
Mailing Address - Phone:817-583-6636
Mailing Address - Fax:817-538-9508
Practice Address - Street 1:1201 N WATSON RD STE 187
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6225
Practice Address - Country:US
Practice Address - Phone:817-583-6636
Practice Address - Fax:817-538-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018099Medicaid