Provider Demographics
NPI:1548764269
Name:ANGELS BY THE WINGS HOME CARE LLC
Entity Type:Organization
Organization Name:ANGELS BY THE WINGS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-553-9306
Mailing Address - Street 1:5227 GRAVOIS AVE 1ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116
Mailing Address - Country:US
Mailing Address - Phone:314-553-9306
Mailing Address - Fax:314-553-9307
Practice Address - Street 1:5227 GRAVOIS AVE 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116
Practice Address - Country:US
Practice Address - Phone:314-553-9306
Practice Address - Fax:314-553-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2222004Medicaid