Healthcare Provider Details

I. General information

NPI: 1760032965
Provider Name (Legal Business Name): CARING WOUNDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MIDDLE ST
FARMINGTON MO
63640-1570
US

IV. Provider business mailing address

733 W MAIN ST
FREDERICKTOWN MO
63645-1113
US

V. Phone/Fax

Practice location:
  • Phone: 660-707-3059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FERNANDO BORREGO
Title or Position: DIRECTOR
Credential:
Phone: 573-783-8875