Healthcare Provider Details

I. General information

NPI: 1760259295
Provider Name (Legal Business Name): INFINITY HOUSING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 RICE CREEK PKWY NE
MINNEAPOLIS MN
55449-6766
US

IV. Provider business mailing address

2913 RICE CREEK PKWY NE
MINNEAPOLIS MN
55449-6766
US

V. Phone/Fax

Practice location:
  • Phone: 612-229-1635
  • Fax:
Mailing address:
  • Phone: 612-229-1635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: ABDETA TULA
Title or Position: OWNER
Credential:
Phone: 612-229-1635