Provider Demographics
NPI:1639625460
Name:WINGS OF HOPE, LLC
Entity Type:Organization
Organization Name:WINGS OF HOPE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-296-9007
Mailing Address - Street 1:382 W HARDEN STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-7516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:382 W HARDEN STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-7516
Practice Address - Country:US
Practice Address - Phone:919-296-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health