Provider Demographics
NPI:1013142322
Name:ANGELWINGS
Entity Type:Organization
Organization Name:ANGELWINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-636-7584
Mailing Address - Street 1:103 REIDS BND
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-7687
Mailing Address - Country:US
Mailing Address - Phone:512-636-7584
Mailing Address - Fax:512-581-3993
Practice Address - Street 1:103 REIDS BND
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-7687
Practice Address - Country:US
Practice Address - Phone:512-636-7584
Practice Address - Fax:512-581-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-17
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherPERSONAL ASSISTANCE SERVICES