Provider Demographics
NPI:1841814928
Name:WOUNDS ON WHEELS LLC
Entity type:Organization
Organization Name:WOUNDS ON WHEELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:LORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED WOUND CARE
Authorized Official - Phone:678-463-3677
Mailing Address - Street 1:210 VALLEY VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5561
Mailing Address - Country:US
Mailing Address - Phone:678-463-3677
Mailing Address - Fax:
Practice Address - Street 1:210 VALLEY VIEW TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5561
Practice Address - Country:US
Practice Address - Phone:678-463-3677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty