Provider Demographics
NPI:1003582891
Name:OPEN WINGS HOME AGENCY LLC
Entity type:Organization
Organization Name:OPEN WINGS HOME AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:ANGELICA
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-319-8209
Mailing Address - Street 1:1548 NE 176TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1445
Mailing Address - Country:US
Mailing Address - Phone:786-319-8209
Mailing Address - Fax:
Practice Address - Street 1:16499 NE 19TH AVE STE 213
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4105
Practice Address - Country:US
Practice Address - Phone:786-319-8209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health