Provider Demographics
NPI:1194283051
Name:ANGEL WINGS, LLC GROUP HOME & PERSONAL AND RESPITE CARE SERVICES
Entity type:Organization
Organization Name:ANGEL WINGS, LLC GROUP HOME & PERSONAL AND RESPITE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CNO
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALDINO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:601-341-6452
Mailing Address - Street 1:100 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-2826
Mailing Address - Country:US
Mailing Address - Phone:769-327-2024
Mailing Address - Fax:769-327-2032
Practice Address - Street 1:100 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2826
Practice Address - Country:US
Practice Address - Phone:769-327-2024
Practice Address - Fax:769-327-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care