Healthcare Provider Details

I. General information

NPI: 1487140992
Provider Name (Legal Business Name): ANGEL WINGS CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 RIVERMONT DR
FRONT ROYAL VA
22630-8224
US

IV. Provider business mailing address

3280 RIVERMONT DR
FRONT ROYAL VA
22630-8224
US

V. Phone/Fax

Practice location:
  • Phone: 540-323-1561
  • Fax: 540-409-5262
Mailing address:
  • Phone: 540-323-1561
  • Fax: 540-409-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-1570
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHCO-1570
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHCO-1570
License Number StateVA

VIII. Authorized Official

Name: DARRELL CALLIS
Title or Position: CEO/DIRECTOR
Credential: M.ED, QMHP
Phone: 540-323-1561