Provider Demographics
NPI:1104338482
Name:INFUSE FIRST HEALTH CARE, PC
Entity type:Organization
Organization Name:INFUSE FIRST HEALTH CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:T
Authorized Official - Last Name:VILA-ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:855-635-6508
Mailing Address - Street 1:512 FLINT PARC CIR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-6157
Mailing Address - Country:US
Mailing Address - Phone:855-635-6508
Mailing Address - Fax:205-428-8480
Practice Address - Street 1:512 FLINT PARC CIR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6157
Practice Address - Country:US
Practice Address - Phone:855-635-6508
Practice Address - Fax:205-428-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-147465251E00000X
AL1-147475251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-147465OtherALABAMA BOARD OF NURSING