Provider Demographics
NPI:1205651122
Name:WINGS OF FAITH LLC
Entity type:Organization
Organization Name:WINGS OF FAITH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEATU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-285-9117
Mailing Address - Street 1:948 LUPINE LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-6733
Mailing Address - Country:US
Mailing Address - Phone:623-285-9117
Mailing Address - Fax:
Practice Address - Street 1:948 LUPINE LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-6733
Practice Address - Country:US
Practice Address - Phone:623-285-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility