Provider Demographics
NPI:1851779219
Name:ANGELS WINGS SYNERGY RETREAT
Entity Type:Organization
Organization Name:ANGELS WINGS SYNERGY RETREAT
Other - Org Name:ANGELS WINGS SYNERGY RETREAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-467-8888
Mailing Address - Street 1:1920 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-1607
Mailing Address - Country:US
Mailing Address - Phone:559-467-8888
Mailing Address - Fax:
Practice Address - Street 1:1920 N 44TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-1607
Practice Address - Country:US
Practice Address - Phone:559-467-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X, 311Z00000X, 315D00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No385H00000XRespite Care FacilityRespite Care