Provider Demographics
NPI:1053099077
Name:ANGEL WINGS COMMUNITY HEALTHCARE CENTER LLC
Entity type:Organization
Organization Name:ANGEL WINGS COMMUNITY HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:601-869-0299
Mailing Address - Street 1:215 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-2827
Mailing Address - Country:US
Mailing Address - Phone:601-869-0299
Mailing Address - Fax:601-680-3216
Practice Address - Street 1:215 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-2827
Practice Address - Country:US
Practice Address - Phone:601-869-0299
Practice Address - Fax:601-680-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty