Provider Demographics
NPI:1376847525
Name:EAGLE'S WINGS HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:EAGLE'S WINGS HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKWANDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-742-3488
Mailing Address - Street 1:350 CORPORATE CENTER CT STE B
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6360
Mailing Address - Country:US
Mailing Address - Phone:770-742-3488
Mailing Address - Fax:770-742-3443
Practice Address - Street 1:350 CORPORATE CENTER CT STE B
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6360
Practice Address - Country:US
Practice Address - Phone:770-742-3488
Practice Address - Fax:770-742-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075R0740251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health