Provider Demographics
NPI:1578317756
Name:WINGS OF NATURE MENTAL HEALTH CARE LLC
Entity Type:Organization
Organization Name:WINGS OF NATURE MENTAL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:APRNCNP
Authorized Official - Phone:216-307-8552
Mailing Address - Street 1:4466 RANCHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2744
Mailing Address - Country:US
Mailing Address - Phone:216-307-8552
Mailing Address - Fax:
Practice Address - Street 1:4466 RANCHVIEW AVE
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2744
Practice Address - Country:US
Practice Address - Phone:216-307-8552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health