Provider Demographics
NPI:1992860340
Name:FRAGILE WINGS ANGELS IN WAITING
Entity Type:Organization
Organization Name:FRAGILE WINGS ANGELS IN WAITING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-925-4611
Mailing Address - Street 1:4725 IKE FRANK RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77517-2751
Mailing Address - Country:US
Mailing Address - Phone:409-457-5276
Mailing Address - Fax:
Practice Address - Street 1:4725 IKE FRANK RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77517-2751
Practice Address - Country:US
Practice Address - Phone:409-457-5276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities