Healthcare Provider Details

I. General information

NPI: 1497460489
Provider Name (Legal Business Name): ARCHOS WOUND SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 S RIVER RD STE 4
DES PLAINES IL
60018-4109
US

IV. Provider business mailing address

1328 MAIN ST
CRETE IL
60417-2131
US

V. Phone/Fax

Practice location:
  • Phone: 708-305-6086
  • Fax:
Mailing address:
  • Phone: 847-800-0957
  • Fax: 847-972-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS VANESSA ADRANEDA
Title or Position: PRACTICE MANAGER
Credential: RN
Phone: 847-800-0957