Healthcare Provider Details

I. General information

NPI: 1205374493
Provider Name (Legal Business Name): AT HOME WOUNDCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WESTON RD STE 200
WESTON FL
33326-3264
US

IV. Provider business mailing address

1500 WESTON RD STE 200
WESTON FL
33326-3264
US

V. Phone/Fax

Practice location:
  • Phone: 347-563-6066
  • Fax:
Mailing address:
  • Phone: 347-563-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME122443
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALONZO GRANT III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-793-6545