Provider Demographics
NPI:1619030251
Name:WINGS OF ANGEL HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:WINGS OF ANGEL HOME HEALTH CARE, LLC
Other - Org Name:WINGS OF ANGEL HOME HEALTH CARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PARKER GREER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-443-8050
Mailing Address - Street 1:16250 NORTHLAND DR
Mailing Address - Street 2:SUITE 241
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5227
Mailing Address - Country:US
Mailing Address - Phone:248-443-8050
Mailing Address - Fax:248-443-8051
Practice Address - Street 1:16250 NORTHLAND DR
Practice Address - Street 2:SUITE 241
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5227
Practice Address - Country:US
Practice Address - Phone:248-443-8050
Practice Address - Fax:248-443-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-9102Medicare PIN