Provider Demographics
NPI:1508430596
Name:TWO WINGS COMMUNITY HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:TWO WINGS COMMUNITY HEALTH SERVICES LLC
Other - Org Name:TWO WINGS COMMUNITY HEALTH SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-517-2396
Mailing Address - Street 1:16070 HIGHWAY 40 E
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-2550
Mailing Address - Country:US
Mailing Address - Phone:985-606-2522
Mailing Address - Fax:985-606-2202
Practice Address - Street 1:1101 W OAK ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2751
Practice Address - Country:US
Practice Address - Phone:985-517-2396
Practice Address - Fax:985-247-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2518666Medicaid