Healthcare Provider Details

I. General information

NPI: 1710603360
Provider Name (Legal Business Name): INFINITY AND BEYOND HOLISTIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 MOUNTAIN SKIES CT
NORTH LAS VEGAS NV
89032-8237
US

IV. Provider business mailing address

6462 N LOSEE RD
NORTH LAS VEGAS NV
89086-0103
US

V. Phone/Fax

Practice location:
  • Phone: 503-995-4455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MUNIRAH BROWN
Title or Position: PRESIDENT
Credential:
Phone: 503-995-4455