MEDICARE: OPEN WINGS IN HOME CARE, LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1558162313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN WINGS IN HOME CARE, LLC

Provider Business Mailing Address
First Line	:	1421 FAIRMEADOWS LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-2512
Country	:	US
Telephone Number	:	870-949-6499
Fax Number	:	888-979-6486

Provider Business Practice Location Address
First Line	:	1421 FAIRMEADOWS LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-2512
Country	:	US
Telephone Number	:	870-949-6499
Fax Number	:	888-979-6486

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. CHUNETTA DALE
Credential	:
Telephone Number	:	870-949-6499

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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