Healthcare Provider Details

I. General information

NPI: 1508303397
Provider Name (Legal Business Name): INFINITY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PEAR ORCHARD PARK
JACKSON MS
39211-2810
US

IV. Provider business mailing address

PO BOX 331
RIDGELAND MS
39158-0331
US

V. Phone/Fax

Practice location:
  • Phone: 601-624-3876
  • Fax: 769-572-7127
Mailing address:
  • Phone: 769-572-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAMEIKA JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-624-3876