# MOUNT EAGLE WINGS PERSONAL CARE HOME, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619204906
- **Authorized official:** VENNA REESE (OWNER/ADMINISTRATOT)
- **Authorized official phone:** (706) 284-9959

## Contact information

- **Practice address:** 4027 PRESCOTT DR, MARTINEZ, GA 30907-4308
- **Practice address phone:** (706) 284-9959
- **Mailing address:** 4027 PRESCOTT DR, MARTINEZ, GA 30907-4308
- **Mailing address phone:** (706) 284-9959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311Z00000X | Custodial Care Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/08/2009
- **Last updated:** 11/08/2009