MEDICARE: INFINITI HUMAN SERVICES,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	253Z00000X	In Home Supportive Care Agency	200904200902	OH

General Provider Information

NPI Number	:	1578986030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITI HUMAN SERVICES,LLC

Provider Business Mailing Address
First Line	:	1639 EMERALD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1238
Country	:	US
Telephone Number	:	614-564-9035
Fax Number	:	614-564-9035

Provider Business Practice Location Address
First Line	:	1639 EMERALD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1238
Country	:	US
Telephone Number	:	614-564-9035
Fax Number	:	614-564-9035

Authorized Official
Title or Position	:	CEO
Name	:	MS. GINA V STUBBS-SCOTT
Credential	:
Telephone Number	:	614-564-9035

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	02/03/2014

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