MEDICARE: INFINITE HOMECARE AGENCY 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	2279H0200X	Home Health Registered Respiratory Therapist

General Provider Information

NPI Number	:	1952230922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE HOMECARE AGENCY LLC

Provider Business Mailing Address
First Line	:	4200 RHAWN ST APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2792
Country	:	US
Telephone Number	:	267-916-4384
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 RHAWN ST APT 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-2792
Country	:	US
Telephone Number	:	267-916-4384
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LADAWN HICKS
Credential	:
Telephone Number	:	267-916-4384

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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