Organization
EAGLE WINGS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J BROCK ACSW (OWNER)
(517) 420-6123
Entity
Organization
Contact information
Practice address
1020 LONG BLVD, #5, LANSING, MI 48911-6896
(517) 420-6123
Mailing address
1538 STONEY PT, LANSING, MI 48917-1450
(517) 323-8395
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6301005177
MI
Other
Enumeration date
10/16/2008
Last updated
10/16/2008
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