Provider Demographics
NPI:1902611643
Name:LIFE SAVER WINGS
Entity type:Organization
Organization Name:LIFE SAVER WINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAJAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-455-9770
Mailing Address - Street 1:17135 ANNCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3525
Mailing Address - Country:US
Mailing Address - Phone:248-455-9770
Mailing Address - Fax:
Practice Address - Street 1:17135 ANNCHESTER RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3525
Practice Address - Country:US
Practice Address - Phone:248-455-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty