Basic Information
| Provider Information | |||||||||
| NPI: | 1881831329 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINGS FOR CHILDREN AND FAMILIES INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 HAMMOND ST | ||||||||
| Address2: | SUITE 915 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044014378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079412988 | ||||||||
| FaxNumber: | 2079412989 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 HAMMOND ST | ||||||||
| Address2: | SUITE 915 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044014378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079412988 | ||||||||
| FaxNumber: | 2079412989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 01/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | NIEDOROWSKI | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2079412988 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 237567 | ME | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 128520000 | 05 | ME | MEDICAID |