Wings of Love of Leesburg, LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

688587096 Issued in FL

Legal business name

WINGS OF LOVE OF LEESBURG, LLC

Practice address

1018 W North Blvd
Leesburg, FL 34748-5057

Phone

(352) 360-0660

Fax

(352) 360-0567

NPI assigned

May 20, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Pernell Mitchell

Title

President

Phone

(352) 360-0660

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1346407111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491077",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347491077",
            "telephone_number": "352-360-0660",
            "fax_number": "352-360-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 W NORTH BLVD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485057",
            "telephone_number": "352-360-0660",
            "fax_number": "352-360-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINGS OF LOVE OF LEESBURG, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "PERNELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-360-0660",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "FL",
            "license": "688587096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VENDOR NUMBER",
            "identifier": "F342051880001",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY & SUPPORT LIVING WAIVER",
            "identifier": "688587098",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDWAIVER PROVIDER NUMBER",
            "identifier": "688587096",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Wilson
• Katrina Wilson
• Keia Wilson
• Wings of Love
• Wings of Love of Leesburg Transport, LLC
• David Alan Wollenschlaeger, D.M.D.
• Alan Wong, D.O.
• Callie Jeannine Woodring, COTA/L
• Ashley R Worrell, PTA
• Efram Dyonne Wright

• Developmentally Disabled Services Day Training Agency in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Developmentally Disabled Services Day Training Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; 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.