Provider Demographics
NPI:1528625472
Name:ANGEL WINGS FAMILY SERVICES OF HAMPTON LLC
Entity type:Organization
Organization Name:ANGEL WINGS FAMILY SERVICES OF HAMPTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-826-1555
Mailing Address - Street 1:110 COLISEUM XING STE 262
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5971
Mailing Address - Country:US
Mailing Address - Phone:757-826-1515
Mailing Address - Fax:757-826-1515
Practice Address - Street 1:2019 CUNNINGHAM DR STE 220
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3316
Practice Address - Country:US
Practice Address - Phone:757-826-1555
Practice Address - Fax:757-826-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty