Provider Demographics
NPI:1437772746
Name:ANGEL WINGS
Entity Type:Organization
Organization Name:ANGEL WINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HERRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LIMITED PROV LICENSE
Authorized Official - Phone:785-259-3371
Mailing Address - Street 1:1340B 280TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-9753
Mailing Address - Country:US
Mailing Address - Phone:785-259-3371
Mailing Address - Fax:
Practice Address - Street 1:1340B 280TH AVE
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-9753
Practice Address - Country:US
Practice Address - Phone:785-259-3371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services