The Wings of Holly Blue LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

THE WINGS OF HOLLY BLUE LLC

Doing business as

Twohb

Practice address

815 S Main St
Moultrie, GA 31768-5434

Phone

(760) 585-5522

Fax

(760) 433-5414

NPI assigned

Feb 27, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Debra Howard

Title

Ceo

Phone

(760) 585-5522

Specialties & licenses 1

Addresses

Other names 1

• TWOHB Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1184480170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685434",
            "telephone_number": "760-585-5522",
            "fax_number": "760-433-5414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 S MAIN ST",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317685434",
            "telephone_number": "760-585-5522",
            "fax_number": "760-433-5414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WINGS OF HOLLY BLUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-27",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-585-5522"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TWOHB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.