Healthcare Provider Details

I. General information

NPI: 1871069252
Provider Name (Legal Business Name): WINGS OF AN ANGEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 04/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 MOUNT AVE
SAINT LOUIS MO
63121-5717
US

IV. Provider business mailing address

6420 MOUNT AVE
ST. LOUIS MO
63121
US

V. Phone/Fax

Practice location:
  • Phone: 314-458-9602
  • Fax: 314-282-0158
Mailing address:
  • Phone: 314-485-9602
  • Fax: 314-282-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBRA WISE
Title or Position: SOLE/OWNER
Credential:
Phone: 314-282-0158