Healthcare Provider Details

I. General information

NPI: 1376893024
Provider Name (Legal Business Name): HEALING WINGS HOME CARE PROVIDERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DARBYS CROSSING DR SUITE 202 E
HIRAM GA
30141-6008
US

IV. Provider business mailing address

1050 POPLAR SPRINGS RD
DALLAS GA
30157-6514
US

V. Phone/Fax

Practice location:
  • Phone: 678-521-8115
  • Fax:
Mailing address:
  • Phone: 678-521-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number110-R-0800
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number110-R-0800
License Number StateGA

VIII. Authorized Official

Name: MR. OLAJIDE A OPALEYE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 678-521-8115