MEDICARE: LA WINGS HOME HEALTH CARE 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	LC6681870	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376616003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA WINGS HOME HEALTH CARE INC.

Provider Business Mailing Address
First Line	:	4030 COTTAGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3204
Country	:	US
Telephone Number	:	314-531-8594
Fax Number	:	314-531-8596

Provider Business Practice Location Address
First Line	:	4030 COTTAGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3204
Country	:	US
Telephone Number	:	314-531-8594
Fax Number	:	314-531-8596

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DELORES JEAN WINGS
Credential	:
Telephone Number	:	314-531-8594

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	06/24/2009

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