=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124365929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFINITY HEALTHCARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2013
-----------------------------------------------------
Last Update Date | 10/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 513 RALEIGH RD SUITE D
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28328-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-592-0006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 E ELIZABETH ST
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28328-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-337-2018
-----------------------------------------------------
Fax | 910-592-0056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. EDDIE PARKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-337-3630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC4084
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------