Provider Demographics
NPI:1851750244
Name:SPREAD YOUR WINGS ASSISTED LIVING
Entity Type:Organization
Organization Name:SPREAD YOUR WINGS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA ALLS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:832-523-5315
Mailing Address - Street 1:1123 HEATHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-2337
Mailing Address - Country:US
Mailing Address - Phone:281-864-5462
Mailing Address - Fax:281-864-5462
Practice Address - Street 1:1318 BAYOU ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-8202
Practice Address - Country:US
Practice Address - Phone:281-864-5462
Practice Address - Fax:281-864-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136493251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care