Provider Demographics
NPI:1184303612
Name:BLUE WINGS LLC
Entity type:Organization
Organization Name:BLUE WINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-562-2091
Mailing Address - Street 1:9436 GRENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6206
Mailing Address - Country:US
Mailing Address - Phone:917-562-2091
Mailing Address - Fax:
Practice Address - Street 1:9436 GRENVILLE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6206
Practice Address - Country:US
Practice Address - Phone:917-562-2091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty