| Wings Of The Future, Nfp | |
|
155 N Lake Ave Fl 8 Pasadena CA 91101-1849 | |
| (661) 402-1545 | |
| (661) 727-0006 |
| Full Name | Wings Of The Future, Nfp |
|---|---|
| Speciality | Social Worker |
| Location | 155 N Lake Ave Fl 8, Pasadena, California |
| Authorized Official Name and Position | Krystal Marie Boothe (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6614021545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wings Of The Future, Nfp 851 S Sunset Ave Apt 119 West Covina CA 91790-5546 Ph: (310) 621-0150 | Wings Of The Future, Nfp 155 N Lake Ave Fl 8 Pasadena CA 91101-1849 Ph: (661) 402-1545 |
| NPI Number | 1194481556 |
|---|---|
| Provider Enumeration Date | 11/10/2021 |
| Last Update Date | 05/03/2024 |
| Certification Date | 05/03/2024 |
| Medicare PECOS PAC ID | 7416391404 |
|---|---|
| Medicare Enrollment ID | O20240217000918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194481556 | NPI | - | NPPES |
| CB394408 | Other | CA | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251B00000X | Case Management | (* (Not Available)) | Secondary |
| Provider Name | Jasmine Singleton-caster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649722083 PECOS PAC ID: 9234410333 Enrollment ID: I20240219000036 |
| Provider Name | Orlando Gabriel Lizardi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366221665 PECOS PAC ID: 2163866849 Enrollment ID: I20240221002396 |
| Provider Name | Melba Chitanda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134901234 PECOS PAC ID: 2668812348 Enrollment ID: I20240429000993 |
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