Provider Demographics
NPI:1184904021
Name:ANGEL'S WINGS OF LOVE, INC
Entity type:Organization
Organization Name:ANGEL'S WINGS OF LOVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-631-8197
Mailing Address - Street 1:PO BOX 3891
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32721-3891
Mailing Address - Country:US
Mailing Address - Phone:386-960-6504
Mailing Address - Fax:
Practice Address - Street 1:910 S ADELLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7326
Practice Address - Country:US
Practice Address - Phone:386-960-6504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003813600253Z00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003813600Medicaid