Provider Demographics
NPI:1376069013
Name:NEYTIRI'S WINGS OF ANGELS PCA,LLC
Entity Type:Organization
Organization Name:NEYTIRI'S WINGS OF ANGELS PCA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:832-461-6640
Mailing Address - Street 1:17000 EL CAMINO REAL STE 307B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2661
Mailing Address - Country:US
Mailing Address - Phone:281-984-7571
Mailing Address - Fax:
Practice Address - Street 1:17000 EL CAMINO REAL STE 307B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2661
Practice Address - Country:US
Practice Address - Phone:281-984-7571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health