Organization
WINGS OF REFUGE, INC
Active
Organization
WINGS OF REFUGE, INC
Active
Other names
Wings of Recovery - Non Residential
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE MONCITO (PRESIDENT & CEO)
(310) 670-6767
Entity
Organization
Contact information
Practice address
38345 30TH ST E, SUITE A-2, PALMDALE, CA 93550-4980
(661) 267-7124
(661) 267-1549
Mailing address
5777 W CENTURY BLVD, SUITE 910, LOS ANGELES, CA 90045-5600
(310) 670-6767
(310) 670-2626
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013213933
DRUG MEDI-CAL
—
01
—
1386940211
DRUG MED-ICAL
—
01
—
1649577206
DRUG MEDI-CAL
—
01
—
1720385883
DRUG MEDI-CAL
—
01
—
1922304856
DRUG MEDI-CAL
—
Enumeration date
05/18/2011
Last updated
05/18/2011
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