Healthcare Provider Details

I. General information

NPI: 1851924625
Provider Name (Legal Business Name): COMMUNITY WOUND RESOURCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N 3RD ST
LONGVIEW TX
75601-6546
US

IV. Provider business mailing address

515 N 3RD ST
LONGVIEW TX
75601-6546
US

V. Phone/Fax

Practice location:
  • Phone: 903-475-3474
  • Fax: 903-942-2930
Mailing address:
  • Phone: 903-475-3474
  • Fax: 903-942-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LACHELLE GRIFFIN
Title or Position: CHIEF HUMAN RESOURCE OFFICER
Credential:
Phone: 769-208-4437