MEDICARE: INFINITE IMPACT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1801753421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE IMPACT LLC

Provider Business Mailing Address
First Line	:	1701 STOCKTON ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-3849
Country	:	US
Telephone Number	:	804-295-8681
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 STOCKTON ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-3849
Country	:	US
Telephone Number	:	804-295-8681
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANIKA CHRISTMAS
Credential	:
Telephone Number	:	804-295-8681

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “INFINITE IMPACT LLC ” Practice Location

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