Provider Demographics
NPI:1205458908
Name:WOUND CARE AT HOME PLLC
Entity type:Organization
Organization Name:WOUND CARE AT HOME PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-429-7860
Mailing Address - Street 1:855 DAVIS BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8218
Mailing Address - Country:US
Mailing Address - Phone:818-429-7860
Mailing Address - Fax:
Practice Address - Street 1:855 DAVIS BLVD STE 500
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8218
Practice Address - Country:US
Practice Address - Phone:818-429-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty