Provider Demographics
NPI:1205476066
Name:OUR WINGS OF HOPE LLC
Entity type:Organization
Organization Name:OUR WINGS OF HOPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINCIAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-741-7596
Mailing Address - Street 1:3812 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6354
Mailing Address - Country:US
Mailing Address - Phone:301-741-7596
Mailing Address - Fax:
Practice Address - Street 1:66 PAINTERS MILL RD STE 204
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3657
Practice Address - Country:US
Practice Address - Phone:443-380-3839
Practice Address - Fax:888-811-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health