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General NPI Number Information
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NPI Number | 1598891079
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Entity Type | Organization
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Legal Business Name | INFINITY HOME CARE OF LAKELAND, LLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 70 4TH ST NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4667
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Country | US
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Telephone | 863-686-6790
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Fax | 863-686-6957
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Provider Business Mailing Address
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Address Line | 3854 AMERICAN WAY SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70816-4013
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Country | US
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Telephone | 225-292-2031
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Fax | 225-295-9678
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL KUSSEROW
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Credential |
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Telephone | 225-292-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 19965386
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 108488
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA299992644
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License Number State | FL
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