Organization
ELITE INFUSION IV HYDRATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAVON PARKER LPN (CEO)
(267) 516-8048
Entity
Organization
Contact information
Practice address
6136 WALNUT ST, PHILADELPHIA, PA 19139-3704
(267) 516-8048
Mailing address
6136 WALNUT ST, PHILADELPHIA, PA 19139-3704
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/04/2020
Last updated
03/04/2020
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