Provider Demographics
NPI:1669298436
Name:WINGS 2 FLY
Entity type:Organization
Organization Name:WINGS 2 FLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DORENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-858-9902
Mailing Address - Street 1:350 GEORGE W LILES PKWY NW STE 160
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2411
Mailing Address - Country:US
Mailing Address - Phone:980-858-9902
Mailing Address - Fax:
Practice Address - Street 1:825 OAKWOOD VILLA
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081
Practice Address - Country:US
Practice Address - Phone:980-858-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health