Provider Demographics
NPI:1902676356
Name:PEORIA WOUND CARE, LLC
Entity Type:Organization
Organization Name:PEORIA WOUND CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:602-460-0725
Mailing Address - Street 1:8827 W BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-8174
Mailing Address - Country:US
Mailing Address - Phone:602-460-0725
Mailing Address - Fax:
Practice Address - Street 1:8827 W BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-8174
Practice Address - Country:US
Practice Address - Phone:602-460-0725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health