Provider Demographics
NPI:1528811155
Name:KOLLERS WINGS
Entity type:Organization
Organization Name:KOLLERS WINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CRC
Authorized Official - Phone:409-227-4757
Mailing Address - Street 1:10554 COOKS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7453
Mailing Address - Country:US
Mailing Address - Phone:409-227-4757
Mailing Address - Fax:409-750-7677
Practice Address - Street 1:10554 COOKS LAKE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-7453
Practice Address - Country:US
Practice Address - Phone:409-227-4757
Practice Address - Fax:409-750-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care