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General NPI Number Information
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NPI Number | 1093535882
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Entity Type | Organization
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Legal Business Name | INFINITY LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 605 US ROUTE 1 STE 9
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9617
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Country | US
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Telephone | 207-347-9614
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Fax | 508-546-8128
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Provider Business Mailing Address
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Address Line | 605 US ROUTE 1 STE 9
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9617
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Country | US
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Telephone | 207-347-9614
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Fax | 508-546-8128
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Authorized Official
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Title or Position | CEO
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Name | PATRICK KAMBU MBENZA
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Credential | MHRTC DSP
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Telephone | 207-347-9614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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