Provider Demographics
NPI:1477765667
Name:ACUTE WOUND CARE LLC
Entity Type:Organization
Organization Name:ACUTE WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:CCT
Authorized Official - Phone:239-949-4412
Mailing Address - Street 1:28200 OLD 41 RD UNIT 208
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-0836
Mailing Address - Country:US
Mailing Address - Phone:239-949-4412
Mailing Address - Fax:877-262-3226
Practice Address - Street 1:28200 OLD 41 RD UNIT 208
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-0836
Practice Address - Country:US
Practice Address - Phone:239-949-4412
Practice Address - Fax:877-262-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107502700Medicaid
FL5963630001Medicare NSC
FL032200800Medicaid