Provider Demographics
NPI:1457946162
Name:HEALED WOUND
Entity type:Organization
Organization Name:HEALED WOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHENDWA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH ADMINISTRATOR
Authorized Official - Phone:757-839-8049
Mailing Address - Street 1:301 CHOATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-4569
Mailing Address - Country:US
Mailing Address - Phone:757-839-8049
Mailing Address - Fax:
Practice Address - Street 1:301 CHOATE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-4569
Practice Address - Country:US
Practice Address - Phone:757-839-8049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health