Healthcare Provider Details

I. General information

NPI: 1861249732
Provider Name (Legal Business Name): INFINITE DEVELOPMENTAL SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 PURSLEY AVE
PENSACOLA FL
32526-1707
US

IV. Provider business mailing address

5999 PURSLEY AVE
PENSACOLA FL
32526-1707
US

V. Phone/Fax

Practice location:
  • Phone: 850-607-3550
  • Fax:
Mailing address:
  • Phone: 850-607-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN HAZZARD
Title or Position: OWNER
Credential:
Phone: 850-293-4911