Provider Demographics
NPI:1043342223
Name:WOUNDCARE ON WHEELS INC
Entity type:Organization
Organization Name:WOUNDCARE ON WHEELS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:CCNS
Authorized Official - Phone:630-898-3360
Mailing Address - Street 1:608 S WASHINGTON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6663
Mailing Address - Country:US
Mailing Address - Phone:630-898-3360
Mailing Address - Fax:630-898-3358
Practice Address - Street 1:608 S WASHINGTON ST
Practice Address - Street 2:STE 101
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6663
Practice Address - Country:US
Practice Address - Phone:630-898-3360
Practice Address - Fax:630-898-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL589630Medicare ID - Type UnspecifiedMEDICARE