Provider Demographics
NPI:1457075814
Name:WINGS GROUP HOME LLC
Entity Type:Organization
Organization Name:WINGS GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA
Authorized Official - Phone:704-258-6366
Mailing Address - Street 1:6346 MORNINGVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0409
Mailing Address - Country:US
Mailing Address - Phone:704-258-6366
Mailing Address - Fax:855-345-0943
Practice Address - Street 1:6346 MORNINGVIEW CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0409
Practice Address - Country:US
Practice Address - Phone:704-258-6366
Practice Address - Fax:855-345-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities