Provider Demographics
NPI:1275180754
Name:EAGLES WINGS HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:EAGLES WINGS HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-568-6166
Mailing Address - Street 1:2540 TURTLE TER
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2830
Mailing Address - Country:US
Mailing Address - Phone:770-568-6166
Mailing Address - Fax:
Practice Address - Street 1:2540 TURTLE TER
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-2830
Practice Address - Country:US
Practice Address - Phone:770-568-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health