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General NPI Number Information
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NPI Number | 1205651122
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Entity Type | Organization
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Legal Business Name | WINGS OF FAITH LLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 948 LUPINE LN
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City | PRESCOTT
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State | AZ
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Zip | 86305-6733
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Country | US
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Telephone | 623-285-9117
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Fax |
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Provider Business Mailing Address
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Address Line | 948 LUPINE LN
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City | PRESCOTT
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State | AZ
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Zip | 86305-6733
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Country | US
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Telephone | 623-285-9117
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EUGEN NEATU
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Credential |
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Telephone | 623-285-9117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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