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General NPI Number Information
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NPI Number | 1164850517
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Entity Type | Organization
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Legal Business Name | ENLIVEN HOME INFUSION SPECIALISTS, LLC
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 11875 W MCDOWELL RD APT 1168
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City | AVONDALE
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State | AZ
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Zip | 85392-3105
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Country | US
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Telephone | 623-698-4725
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Fax |
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Provider Business Mailing Address
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Address Line | 11875 W MCDOWELL RD APT 1168
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City | AVONDALE
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State | AZ
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Zip | 85392-3105
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Country | US
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Telephone | 623-698-4725
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERICK MIRAMONTES
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Credential | MBA
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Telephone | 623-698-4725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | L18512080
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License Number State | AZ
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