MEDICARE: INFINITY FAMILY CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1336909605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY FAMILY CARE LLC

Provider Business Mailing Address
First Line	:	878 W STAR ST
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-0844
Country	:	US
Telephone Number	:	252-417-6829
Fax Number	:	252-298-5413

Provider Business Practice Location Address
First Line	:	203 0LDWELL DRIVE
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834
Country	:	US
Telephone Number	:	252-417-6829
Fax Number	:	252-298-5413

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	WILLIAM T GORHAM
Credential	:
Telephone Number	:	252-417-6829

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	04/13/2024

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