Provider Demographics
NPI:1689674459
Name:WINGS HOME CARE
Entity Type:Organization
Organization Name:WINGS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLYNDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-310-5888
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-0235
Mailing Address - Country:US
Mailing Address - Phone:817-310-5888
Mailing Address - Fax:817-514-2059
Practice Address - Street 1:1560 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6456
Practice Address - Country:US
Practice Address - Phone:817-310-5888
Practice Address - Fax:817-514-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services