Organization
SPREADING MY WINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK PRUITT (CEO)
(770) 668-3915
Entity
Organization
Contact information
Practice address
75 ARCADO RD SW, LILBURN, GA 30047-3084
(770) 668-3915
Mailing address
75 ARCADO RD SW, LILBURN, GA 30047-3084
(770) 668-3915
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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