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General NPI Number Information
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NPI Number | 1669298436
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Entity Type | Organization
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Legal Business Name | WINGS 2 FLY
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 825 OAKWOOD VILLA
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City | KANNAPOLIS
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State | NC
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Zip | 28081
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Country | US
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Telephone | 980-858-9902
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Fax |
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Provider Business Mailing Address
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Address Line | 350 GEORGE W LILES PKWY NW STE 160
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City | CONCORD
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State | NC
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Zip | 28027-2411
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Country | US
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Telephone | 980-858-9902
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DORENDA DURR
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Credential |
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Telephone | 980-858-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health 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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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