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General NPI Number Information
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NPI Number | 1720317092
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Entity Type | Organization
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Legal Business Name | INFINITY CARE INC.
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 324 ROBIN LN
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City | LUXEMBURG
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State | WI
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Zip | 54217-1369
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Country | US
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Telephone | 920-845-5085
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Fax | 920-845-5086
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Provider Business Mailing Address
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Address Line | 324 ROBIN LN
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City | LUXEMBURG
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State | WI
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Zip | 54217-1369
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Country | US
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Telephone | 920-845-5085
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Fax | 920-845-5086
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Authorized Official
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Title or Position | COORDINATOR
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Name | MR. RANDALL J VAN PAY
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Credential |
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Telephone | 920-845-5085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 0012647
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License Number State | WI
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