Provider Demographics
NPI:1629807375
Name:HOME REACH MOBILE WOUND CARE CLINIC, PLLC
Entity type:Organization
Organization Name:HOME REACH MOBILE WOUND CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:AULT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:580-775-1820
Mailing Address - Street 1:115 W. LABERTH RD, SUITE E
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2027
Mailing Address - Country:US
Mailing Address - Phone:580-775-1820
Mailing Address - Fax:903-213-9263
Practice Address - Street 1:115 W LAMBERTH RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2658
Practice Address - Country:US
Practice Address - Phone:877-258-6331
Practice Address - Fax:718-362-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty