Healthcare Provider Details

I. General information

NPI: 1164037313
Provider Name (Legal Business Name): TRES WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 W QUINCY ST
CHICAGO IL
60644-4338
US

IV. Provider business mailing address

5241 W QUINCY ST
CHICAGO IL
60644-4338
US

V. Phone/Fax

Practice location:
  • Phone: 773-398-0014
  • Fax:
Mailing address:
  • Phone: 773-398-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LAPORTIA SIMS
Title or Position: OWNER/RN
Credential: RN
Phone: 773-398-0014