Provider Demographics
NPI:1164850517
Name:ENLIVEN HOME INFUSION SPECIALISTS, LLC
Entity Type:Organization
Organization Name:ENLIVEN HOME INFUSION SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRAMONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:623-698-4725
Mailing Address - Street 1:11875 W MCDOWELL RD APT 1168
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-3105
Mailing Address - Country:US
Mailing Address - Phone:623-698-4725
Mailing Address - Fax:
Practice Address - Street 1:11875 W MCDOWELL RD APT 1168
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-3105
Practice Address - Country:US
Practice Address - Phone:623-698-4725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL18512080251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion