Organization Name: | WITH EAGLE'S WINGS |
NPI Number: | 1578765749 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LEON EDWARD WAKEFIELD (EXECUTIVE DIRECTOR) |
Mailing Address: | 11 Great Plain Road Arapahoe |
State: | WY US |
Postal Code: | 825240197 |
Phone Number: | 3078575940 |
Fax Number: | 3078575932 |
NPI Enumeration Date: | 06/01/2007 |
NPI Last Update Date: | 08/23/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |