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General NPI Number Information
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NPI Number | 1851793970
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Entity Type | Organization
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Legal Business Name | ANGEL WINGS ACTIVITY CENTER, CORP
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 3427 W. WOOLBRIGHT RD.
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City | BOYNTON BEACH
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State | FL
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Zip | 33436
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Country | US
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Telephone | 561-737-0405
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Fax | 561-737-0409
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Provider Business Mailing Address
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Address Line | 3427 W WOOLBRIGHT RD
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-7246
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Country | US
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Telephone | 561-737-0405
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Fax | 561-737-0409
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Authorized Official
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Title or Position | OWNER/ ADMINISTRATOR
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Name | MS. EVELYN GARCIA
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Credential |
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Telephone | 561-737-0405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 9287
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License Number State | FL
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