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General NPI Number Information
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NPI Number | 1659937670
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Entity Type | Organization
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Legal Business Name | INFINITE SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 2201 S BAY ST # A5
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City | EUSTIS
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State | FL
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Zip | 32726-6300
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Country | US
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Telephone | 407-986-7557
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 246
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City | ZELLWOOD
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State | FL
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Zip | 32798-0246
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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 | ADMINISTRATOR
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Name | DEPORSHIA BLACKMON
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Credential |
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Telephone | 407-986-7557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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