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General NPI Number Information
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NPI Number | 1508379140
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Entity Type | Organization
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Legal Business Name | INFINITE CARE ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 480 NW 123RD ST
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City | NORTH MIAMI
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State | FL
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Zip | 33168-3545
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Country | US
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Telephone | 202-779-8655
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Fax |
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Provider Business Mailing Address
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Address Line | 1023 NE 143RD ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-2427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | JUDINE TESSIER HITCHMON
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Credential | LCSW
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Telephone | 202-779-8655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW12345
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9327912
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9319235
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License Number State | FL
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Taxonomy #10
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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