Healthcare Provider Details

I. General information

NPI: 1750433819
Provider Name (Legal Business Name): ANGEL WINGS HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 FRANKLIN TPKE SUITE 6
DANVILLE VA
24540-1362
US

IV. Provider business mailing address

1115 FRANKLIN TPKE SUITE 6
DANVILLE VA
24540-1362
US

V. Phone/Fax

Practice location:
  • Phone: 434-770-8752
  • Fax:
Mailing address:
  • Phone: 434-770-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JULIA ANN MCKINNIS
Title or Position: PRESIDENT, ADMINISTRATOR, DIRECTOR
Credential: RN
Phone: 434-770-8752