MEDICARE: LA WINGS HOME HEALTH CARE II INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	00933247	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043448483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA WINGS HOME HEALTH CARE II INC

Provider Business Mailing Address
First Line	:	8907 SAINT CHARLES ROCK RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-4237
Country	:	US
Telephone Number	:	314-890-9060
Fax Number	:	314-890-9082

Provider Business Practice Location Address
First Line	:	8907 SAINT CHARLES ROCK RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-4237
Country	:	US
Telephone Number	:	314-890-9060
Fax Number	:	314-890-9082

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LYNETTA WINGS
Credential	:
Telephone Number	:	314-890-9060

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	02/24/2010

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