MEDICARE: ANGELS WITH BROKEN WINGS

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	177F00000X	Lodging Provider

General Provider Information

NPI Number	:	1710619721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS WITH BROKEN WINGS

Provider Business Mailing Address
First Line	:	PO BOX 14291
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88013-4291
Country	:	US
Telephone Number	:	575-288-8766
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 E GRIGGS AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2644
Country	:	US
Telephone Number	:	575-288-8766
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GINGER SHANNON
Credential	:	CPSW
Telephone Number	:	575-288-8766

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

Similar Medicare Providers

1194919308 — PUERTO RICO CARE RESPONSE HOME HEALTH AGENCY CORP.
Practice Location Address:

AVE. LAS AMERICAS , URB. CONSTANCIA # 2644-A
PONCE, PR
00717

Practice Phone: 787-290-2351
Practice Fax: 787-290-2352

1821259078 — MS. EDITH E SERRANO
Practice Location Address:

2750 S DURANGO DR , APT 2042
LAS VEGAS, NV
89117-2644

Practice Phone: 702-203-1395
Practice Fax:

1801211974 — KESHIA GRAY
Practice Location Address:

309 FREDERICK AVE
LAS VEGAS, NV
89106-2644

Practice Phone: 702-350-5980
Practice Fax:

1922553650 — MARISA SWAIN
Practice Location Address:

133 LAS PALMAS AVE
VALLEJO, CA
94589-2644

Practice Phone: 510-556-4544
Practice Fax:

1063293223 — AARON SCOTT JACKSON
Practice Location Address:

6929 WATER PIPIT ST
NORTH LAS VEGAS, NV
89084-2644

Practice Phone: 702-845-4068
Practice Fax:

1811825805 — JANA LYNN VARGAS
Practice Location Address:

116 W LAS CRUCES AVE
LAS CRUCES, NM
88001-1226

Practice Phone: 575-652-3378
Practice Fax: 575-652-4466

Directions to “ANGELS WITH BROKEN WINGS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.