Provider Demographics
NPI:1881291672
Name:W I N G S COMMUNITY SUPPORT & RECOVERY SERVICES
Entity type:Organization
Organization Name:W I N G S COMMUNITY SUPPORT & RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SPERLISHA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:AYENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-572-4132
Mailing Address - Street 1:5360 SONORA RD
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-9663
Mailing Address - Country:US
Mailing Address - Phone:270-572-4132
Mailing Address - Fax:
Practice Address - Street 1:401 N MILES ST # B101
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1834
Practice Address - Country:US
Practice Address - Phone:270-572-4132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty