Provider Demographics
NPI:1073887675
Name:NORTHWEST CARE LLC
Entity type:Organization
Organization Name:NORTHWEST CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-226-7610
Mailing Address - Street 1:11880 BUSTLETON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2538
Mailing Address - Country:US
Mailing Address - Phone:215-310-9666
Mailing Address - Fax:215-966-1734
Practice Address - Street 1:11880 BUSTLETON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2538
Practice Address - Country:US
Practice Address - Phone:215-310-9666
Practice Address - Fax:215-966-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA120123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport