Provider Demographics
NPI:1053946996
Name:NORTHWEST INFUSION CENTER LLC
Entity type:Organization
Organization Name:NORTHWEST INFUSION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ACEVEDO MARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-882-6100
Mailing Address - Street 1:PO BOX 250139
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0139
Mailing Address - Country:US
Mailing Address - Phone:787-882-6100
Mailing Address - Fax:
Practice Address - Street 1:13 CALLE PADRE FELICIANO
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2215
Practice Address - Country:US
Practice Address - Phone:787-896-1057
Practice Address - Fax:787-896-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion