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General NPI Number Information
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NPI Number | 1134996150
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Entity Type | Organization
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Legal Business Name | WELLNESS WINGS HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 06/21/2025
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Provider Practice Location Address
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Address Line | 1967 HARDEE ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-7157
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Country | US
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Telephone | 904-521-4627
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Fax |
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Provider Business Mailing Address
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Address Line | 11111 SAN JOSE BLVD STE 56
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7274
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Country | US
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Telephone | 904-521-4627
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEIA KASHAY HOUSTON
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Credential |
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Telephone | 904-521-4627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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