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General NPI Number Information
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NPI Number | 1508351305
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Entity Type | Organization
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Legal Business Name | ANGEL WINGS CARE SERVICES
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 3280 RIVERMONT DR
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City | FRONT ROYAL
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State | VA
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Zip | 22630-8224
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Country | US
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Telephone | 540-323-1561
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Fax |
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Provider Business Mailing Address
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Address Line | 3280 RIVERMONT DR
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City | FRONT ROYAL
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State | VA
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Zip | 22630-8224
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Country | US
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Telephone | 540-323-1561
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DARRELL CALLIS
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Credential | M.ED, QMHP
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Telephone | 540-323-1561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | HCO-1570
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License Number State | VA
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