1730984428 NPI number — HAVILAH MOBILE WOUND HEALING SERVICES LLC

Table of content: CHRISTOPHER THOMAS CATALANO BA (NPI 1598401333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730984428 NPI number — HAVILAH MOBILE WOUND HEALING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVILAH MOBILE WOUND HEALING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730984428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7308 FOREST BEND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75002-6817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-922-4510
Provider Business Mailing Address Fax Number:
972-442-0113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7308 FOREST BEND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75002-6817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-922-4510
Provider Business Practice Location Address Fax Number:
972-442-0113
Provider Enumeration Date:
02/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
EZIAKU
Authorized Official Middle Name:
JENNIFER
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
972-922-4510

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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