=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396159166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MA'S ANGELS WINGS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2014
-----------------------------------------------------
Last Update Date | 06/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2741 E 29TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16510-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-881-3647
-----------------------------------------------------
Fax | 626-672-3626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 818 STATE ST STE A
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16501-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-881-3647
-----------------------------------------------------
Fax | 626-672-3626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. TINA MARIE ABRAMCZYK
-----------------------------------------------------
Credential | BSN RN
-----------------------------------------------------
Telephone | 814-881-3647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------