Provider Demographics
NPI:1245806223
Name:ANGELS BY THE WINGS CDS LLC
Entity type:Organization
Organization Name:ANGELS BY THE WINGS CDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-553-9306
Mailing Address - Street 1:5227 GRAVOIS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2309
Mailing Address - Country:US
Mailing Address - Phone:314-553-9306
Mailing Address - Fax:314-553-9307
Practice Address - Street 1:5227 GRAVOIS AVE FL 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-2309
Practice Address - Country:US
Practice Address - Phone:314-553-9306
Practice Address - Fax:314-553-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health