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General NPI Number Information
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NPI Number | 1770931008
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Entity Type | Organization
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Legal Business Name | INFINITY GROUPS HOMES LLC
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 12643 N 22ND AVE
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City | PHOENIX
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State | AZ
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Zip | 85029-2652
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Country | US
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Telephone | 480-907-4474
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Fax |
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Provider Business Mailing Address
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Address Line | 15111 N 33RD PL
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City | PHOENIX
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State | AZ
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Zip | 85032-4552
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Country | US
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Telephone | 480-907-4474
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOZAMIL GABIR ABDELRAHMAN
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Credential |
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Telephone | 480-907-4474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | BH4839
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License Number State | AZ
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