Provider Demographics
NPI:1639516735
Name:OPEN WINGS LLC
Entity Type:Organization
Organization Name:OPEN WINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNOWDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-629-4834
Mailing Address - Street 1:5072 SUBLIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4059
Mailing Address - Country:US
Mailing Address - Phone:702-629-4834
Mailing Address - Fax:
Practice Address - Street 1:5072 SUBLIGHT AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4059
Practice Address - Country:US
Practice Address - Phone:702-629-4834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1669735247Medicaid
NV1336492701Medicaid
NV1457600645Medicaid
NV1295098788Medicaid