MEDICARE: INFINITE BLESSINGS CARE HOME INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1831870393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE BLESSINGS CARE HOME INC.

Provider Business Mailing Address
First Line	:	732 VIEW LN
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1896
Country	:	US
Telephone Number	:	909-714-4373
Fax Number	:

Provider Business Practice Location Address
First Line	:	23711 PROSPECT VALLEY DR
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1637
Country	:	US
Telephone Number	:	909-895-7262
Fax Number	:	909-895-7262

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JAIME DURAN
Credential	:
Telephone Number	:	909-714-4373

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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