Provider Demographics
NPI:1497239446
Name:UNDER ANGEL WINGS CARE HOME L.L.C
Entity Type:Organization
Organization Name:UNDER ANGEL WINGS CARE HOME L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:602-568-3714
Mailing Address - Street 1:18468 W MONTEROSA ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-6457
Mailing Address - Country:US
Mailing Address - Phone:602-568-3714
Mailing Address - Fax:
Practice Address - Street 1:18468 W MONTEROSA ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-6457
Practice Address - Country:US
Practice Address - Phone:602-568-3714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility