Healthcare Provider Details

I. General information

NPI: 1013501097
Provider Name (Legal Business Name): NFINITY PRIVATE DUTY HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 COLUMBIA AVE STE B
PRENTISS MS
39474
US

IV. Provider business mailing address

PO BOX 177
PRENTISS MS
39474-0177
US

V. Phone/Fax

Practice location:
  • Phone: 601-441-3537
  • Fax:
Mailing address:
  • Phone: 844-244-2430
  • Fax: 844-244-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY GHOLAR
Title or Position: CEO
Credential:
Phone: 601-441-3537