MEDICARE: INFINITY TREATMENT CENTERS OF AMERICA 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1811650617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY TREATMENT CENTERS OF AMERICA LLC

Provider Business Mailing Address
First Line	:	790 TURNPIKE ST STE 300
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6129
Country	:	US
Telephone Number	:	678-296-0842
Fax Number	:	803-932-9618

Provider Business Practice Location Address
First Line	:	790 TURNPIKE ST STE 300
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-6129
Country	:	US
Telephone Number	:	678-296-0842
Fax Number	:	803-932-9618

Authorized Official
Title or Position	:	OWNER
Name	:	MOINUDDIN H MUTTAKIN
Credential	:	MD
Telephone Number	:	803-220-2238

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	11/06/2024

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