Provider Demographics
NPI:1194269316
Name:ANGEL WINGS HOMES
Entity type:Organization
Organization Name:ANGEL WINGS HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-896-2489
Mailing Address - Street 1:2232 PALMER TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1962
Mailing Address - Country:US
Mailing Address - Phone:817-896-2489
Mailing Address - Fax:972-639-3429
Practice Address - Street 1:2232 PALMER TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1962
Practice Address - Country:US
Practice Address - Phone:817-896-2489
Practice Address - Fax:972-639-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802588455251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health