Organization
W I N G S COMMUNITY SUPPORT & RECOVERY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SPERLISHA VICTORIA AYENI (CHIEF OPERATIONS OFFICER)
(270) 572-4132
Entity
Organization
Contact information
Practice address
401 N MILES ST # B101, ELIZABETHTOWN, KY 42701-1834
(270) 572-4132
Mailing address
5360 SONORA RD, HODGENVILLE, KY 42748-9663
(270) 572-4132
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
10/05/2020
Last updated
02/05/2021
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