Healthcare Provider Details

I. General information

NPI: 1659520567
Provider Name (Legal Business Name): INFINITE CARE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 RISING SUN AVE
PHILADELPHIA PA
19111-5228
US

IV. Provider business mailing address

6445 RISING SUN AVE
PHILADELPHIA PA
19111-5228
US

V. Phone/Fax

Practice location:
  • Phone: 215-742-3247
  • Fax:
Mailing address:
  • Phone: 215-742-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number01980501
License Number StatePA

VIII. Authorized Official

Name: JULIO SCOTT MIRANDA
Title or Position: VICE PRESIDENT
Credential:
Phone: 215-742-3247