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General NPI Number Information
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NPI Number | 1912811266
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Entity Type | Organization
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Legal Business Name | W. 89TH AVE. OPCO LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 201 W 89TH AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6283
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Country | US
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Telephone | 954-716-2790
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Fax |
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Provider Business Mailing Address
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Address Line | 7 N WATERLOO ROAD PO BOX 155
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City | DEVON
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State | PA
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Zip | 19333
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. SERGIO CRUZ
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Credential |
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Telephone | 484-396-2138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NULL
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