Healthcare Provider Details

I. General information

NPI: 1477058832
Provider Name (Legal Business Name): INFINITE SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 N WASHINGTON ST
ZELLWOOD FL
32798-9661
US

IV. Provider business mailing address

129 GROVE RIDGE CIRCLE 104
LEESBURG FL
34748
US

V. Phone/Fax

Practice location:
  • Phone: 352-346-0831
  • Fax:
Mailing address:
  • Phone: 352-346-0831
  • Fax: 407-814-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DEPORSHIA BLACKMON
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-346-0831