Provider Demographics
NPI:1821342122
Name:ON ANGEL'S WINGS, INC.
Entity Type:Organization
Organization Name:ON ANGEL'S WINGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-780-5690
Mailing Address - Street 1:23015 N 15TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1323
Mailing Address - Country:US
Mailing Address - Phone:623-780-5690
Mailing Address - Fax:623-780-5692
Practice Address - Street 1:23015 N 15TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1323
Practice Address - Country:US
Practice Address - Phone:623-780-5690
Practice Address - Fax:623-780-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ786824251C00000X, 253Z00000X, 320900000X, 343900000X, 385H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child