MEDICARE: INFINITY BEHAVIORAL SYSTEMS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		IN

General Provider Information

NPI Number	:	1013361294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY BEHAVIORAL SYSTEMS LLC

Provider Business Mailing Address
First Line	:	1318 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-3919
Country	:	US
Telephone Number	:	574-204-2935
Fax Number	:	574-387-4794

Provider Business Practice Location Address
First Line	:	1318 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-3919
Country	:	US
Telephone Number	:	574-204-2935
Fax Number	:	574-387-4794

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CARL RICHARD SPICER
Credential	:	BA,MSW,MBA
Telephone Number	:	574-204-2935

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	04/14/2016

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