Provider Demographics
NPI:1962104125
Name:ENHANCED HEALTHCARE WOUND CLINIC NWA INC
Entity type:Organization
Organization Name:ENHANCED HEALTHCARE WOUND CLINIC NWA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:479-278-2753
Mailing Address - Street 1:5 THACKERY LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-4501
Mailing Address - Country:US
Mailing Address - Phone:870-370-6256
Mailing Address - Fax:
Practice Address - Street 1:5102 W PAULINE WHITAKER PKWY STE 124
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8365
Practice Address - Country:US
Practice Address - Phone:479-278-2753
Practice Address - Fax:479-278-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center