Provider Demographics
NPI:1558162313
Name:OPEN WINGS IN HOME CARE, LLC
Entity type:Organization
Organization Name:OPEN WINGS IN HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHUNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-949-6499
Mailing Address - Street 1:1421 FAIRMEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2512
Mailing Address - Country:US
Mailing Address - Phone:870-949-6499
Mailing Address - Fax:888-979-6486
Practice Address - Street 1:1421 FAIRMEADOWS LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2512
Practice Address - Country:US
Practice Address - Phone:870-949-6499
Practice Address - Fax:888-979-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based