Mount Eagle Wings Personal Care Home, Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

MOUNT EAGLE WINGS PERSONAL CARE HOME, INC

Practice address

4027 Prescott Dr
Martinez, GA 30907-4308

Phone

(706) 284-9959

NPI assigned

Nov 8, 2009

Organization subpart

No

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

Authorized official

Name

Venna ReeseNPI 1659607661

Title

Owner/Administratot

Phone

(706) 284-9959

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Venna Reese, HEALTH PROFESSION

  • Developmental Disabilities Clinic/Center
  • Martinez, GA
  • NPI 1659607661
  NPD (past) Authorized official

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

{
    "created_epoch": "1257638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257638400000",
    "number": "1619204906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4027 PRESCOTT DR",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309074308",
            "telephone_number": "706-284-9959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4027 PRESCOTT DR",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309074308",
            "telephone_number": "706-284-9959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT EAGLE WINGS PERSONAL CARE HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-08",
        "last_updated": "2009-11-08",
        "status": "A",
        "authorized_official_last_name": "REESE",
        "authorized_official_first_name": "VENNA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOT",
        "authorized_official_telephone_number": "706-284-9959"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacie Marie Morris, OTR/L
• Ashley Morrison
• Morse Speech Therapy and Educational Services, LLC
• Stephanie Morse, M. ED., CCC-SLP
• Tyshawn Morton
• Mount Eagles Wings Inc
• Tonya Moyd
• Eliza Mrvan, LPC
• Kaitlyn Elyse Muni, RBT
• Jaleah Murphy

• Adult Care Home Facility in Martinez, GA
• Providers in Martinez, GA by specialty
• Adult Care Home Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2009; 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.