=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265364012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELWINGS CARE NURSE REGISTRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2026
-----------------------------------------------------
Last Update Date | 06/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5916 NW 56TH CIR
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-766-0610
-----------------------------------------------------
Fax | 954-715-6116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5916 NW 56TH CIR
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-766-0610
-----------------------------------------------------
Fax | 954-715-6116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DELORES HEADLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-638-5056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------