Provider Demographics
NPI:1568649093
Name:WINGO FAMILY CARE HOME
Entity type:Organization
Organization Name:WINGO FAMILY CARE HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:WINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-241-3237
Mailing Address - Street 1:5400 BUCKS GARAGE RD
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-9023
Mailing Address - Country:US
Mailing Address - Phone:980-241-3237
Mailing Address - Fax:
Practice Address - Street 1:5400 BUCKS GARAGE RD
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-9023
Practice Address - Country:US
Practice Address - Phone:980-241-3237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-018-029311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home