Provider Demographics
NPI:1750550216
Name:YUMA INFUSION THERAPY, LLC
Entity type:Organization
Organization Name:YUMA INFUSION THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PERLEY
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:NESTRICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:928-708-0025
Mailing Address - Street 1:1151 W IRON SPRINGS RD
Mailing Address - Street 2:STE G
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1614
Mailing Address - Country:US
Mailing Address - Phone:928-708-0025
Mailing Address - Fax:928-708-0288
Practice Address - Street 1:2170 1/2 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-373-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESCOTT IV CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0048653336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ320658Medicaid
AZ320658Medicaid