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NPI Code Detail

MEDICARE: WINGS OF REFUGE, INC.

MEDICARE: WINGS OF REFUGE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302F00000XExclusive Provider Organization

General Provider Information

NPI Number : 1649577206
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINGS OF REFUGE, INC.
Provider Business Mailing Address
First Line : 5777 W CENTURY BLVD
Second Line : SUITE 910
City : LOS ANGELES
State : CA
Zip : 90045-5600
Country : US
Telephone Number : 310-670-6767
Fax Number : 310-670-2626
Provider Business Practice Location Address
First Line : 2516 W. 54TH STREET
Second Line :
City : LOS ANGELES
State : CA
Zip : 90043
Country : US
Telephone Number : 323-296-6573
Fax Number : 310-670-2626
Authorized Official
Title or Position : PRESIDENT & CEO
Name : RENEE MONCITO
Credential : PHD
Telephone Number : 310-670-6767
Provider Enumeration Date : 02/17/2011
Last Update Date : 02/17/2011

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Directions to “WINGS OF REFUGE, INC. ” Practice Location

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