Provider Demographics
NPI:1902470420
Name:WINGS OVER VIRGINIA LLC
Entity Type:Organization
Organization Name:WINGS OVER VIRGINIA LLC
Other - Org Name:WINGS OVER VIRGINIA HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-392-9684
Mailing Address - Street 1:6325 N CENTER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-0020
Mailing Address - Country:US
Mailing Address - Phone:757-392-9684
Mailing Address - Fax:
Practice Address - Street 1:6325 N CENTER DR STE 204
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-0020
Practice Address - Country:US
Practice Address - Phone:757-392-9684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based