Healthcare Provider Details

I. General information

NPI: 1013811157
Provider Name (Legal Business Name): INFINITE SUPPORTS NWF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 US HIGHWAY 90
COTTONDALE FL
32431-7002
US

IV. Provider business mailing address

2870 US HIGHWAY 90
COTTONDALE FL
32431-7002
US

V. Phone/Fax

Practice location:
  • Phone: 850-693-0411
  • Fax: 334-292-2088
Mailing address:
  • Phone: 850-693-0411
  • Fax: 334-292-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. THERESA DIRLEAN DANIELS
Title or Position: PRESIDENT
Credential:
Phone: 850-693-0411