MEDICARE: WINGS OF AN ANGEL 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
2	253Z00000X	In Home Supportive Care Agency
3	372600000X	Adult Companion	24912	FL
4	374U00000X	Home Health Aide
5	251J00000X	Nursing Care Agency

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174017495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINGS OF AN ANGEL INC

Provider Business Mailing Address
First Line	:	7957 ORLEANS ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-3561
Country	:	US
Telephone Number	:	786-985-0690
Fax Number	:	754-888-9175

Provider Business Practice Location Address
First Line	:	3600 S STATE ROAD 7 STE 21
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-5288
Country	:	US
Telephone Number	:	754-888-9074
Fax Number	:	754-888-9110

Authorized Official
Title or Position	:	CEO
Name	:	DENEZE M DOUGLAS
Credential	:
Telephone Number	:	786-985-0690

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	10/15/2025

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Directions to “WINGS OF AN ANGEL INC ” Practice Location

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