Provider Demographics
NPI:1730984428
Name:HAVILAH MOBILE WOUND HEALING SERVICES LLC
Entity type:Organization
Organization Name:HAVILAH MOBILE WOUND HEALING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EZIAKU
Authorized Official - Middle Name:JENNIFER
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-922-4510
Mailing Address - Street 1:7308 FOREST BEND DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:TX
Mailing Address - Zip Code:75002-6817
Mailing Address - Country:US
Mailing Address - Phone:972-922-4510
Mailing Address - Fax:972-442-0113
Practice Address - Street 1:7308 FOREST BEND DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:TX
Practice Address - Zip Code:75002-6817
Practice Address - Country:US
Practice Address - Phone:972-922-4510
Practice Address - Fax:972-442-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty