Provider Demographics
NPI:1699466482
Name:HEALING HANDS IV INFUSION CENTER LLC
Entity type:Organization
Organization Name:HEALING HANDS IV INFUSION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUPITER
Authorized Official - Middle Name:AMBROISE
Authorized Official - Last Name:FLEURIMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:561-473-5723
Mailing Address - Street 1:3141 S MILITARY TRL STE 108
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2133
Mailing Address - Country:US
Mailing Address - Phone:561-557-2223
Mailing Address - Fax:561-473-5717
Practice Address - Street 1:3141 S MILITARY TRL STE 108
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-2133
Practice Address - Country:US
Practice Address - Phone:561-557-2223
Practice Address - Fax:561-473-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13849OtherHEALTHCARE CLINIC