Provider Demographics
NPI:1245654961
Name:ANGEL WINGS NURSING SERVICES LLC
Entity type:Organization
Organization Name:ANGEL WINGS NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TARESS
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-437-9521
Mailing Address - Street 1:320 BROOKES DR
Mailing Address - Street 2:200
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2736
Mailing Address - Country:US
Mailing Address - Phone:314-942-2994
Mailing Address - Fax:
Practice Address - Street 1:320 BROOKES DR
Practice Address - Street 2:200
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2736
Practice Address - Country:US
Practice Address - Phone:314-942-2994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1357020374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty