Provider Demographics
NPI:1023432143
Name:ANGEL WINGS ADULT DAY SERVICES, LLC
Entity type:Organization
Organization Name:ANGEL WINGS ADULT DAY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN/MSN
Authorized Official - Phone:713-384-9322
Mailing Address - Street 1:19334 LITTLE PINE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4567
Mailing Address - Country:US
Mailing Address - Phone:713-366-9130
Mailing Address - Fax:
Practice Address - Street 1:19334 LITTLE PINE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4567
Practice Address - Country:US
Practice Address - Phone:713-366-9130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health