Provider Demographics
NPI:1558681189
Name:ANGEL WINGS OF LOUISIANA, LLC
Entity Type:Organization
Organization Name:ANGEL WINGS OF LOUISIANA, LLC
Other - Org Name:ANGEL WINGS MEDICAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CODY
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-347-6974
Mailing Address - Street 1:2732 DESTREHAN AVE APT C
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-6420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2732 DESTREHAN AVE APT C
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-6420
Practice Address - Country:US
Practice Address - Phone:504-347-6974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WATSON HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)