Healthcare Provider Details

I. General information

NPI: 1124547542
Provider Name (Legal Business Name): INFINITY ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 FIRST COLONY CIR
COLUMBUS MS
39702-7900
US

IV. Provider business mailing address

64 FIRST COLONY CIR
COLUMBUS MS
39702-7900
US

V. Phone/Fax

Practice location:
  • Phone: 662-435-5404
  • Fax:
Mailing address:
  • Phone: 662-435-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1154241
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR877178
License Number StateMS

VIII. Authorized Official

Name: MRS. ROSHUNICA ROCHELLE MURRAY
Title or Position: OWNER/CEO
Credential: RN
Phone: 662-435-5404