Healthcare Provider Details

I. General information

NPI: 1225801467
Provider Name (Legal Business Name): INFINIUM HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MID RIVERS MALL DR STE 4
SAINT PETERS MO
63376-2171
US

IV. Provider business mailing address

1000 MID RIVERS MALL DR STE 4
SAINT PETERS MO
63376-2171
US

V. Phone/Fax

Practice location:
  • Phone: 331-257-5657
  • Fax:
Mailing address:
  • Phone: 331-257-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDISS JULIAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 331-257-5657