MEDICARE: INFINITE GRACE HOMECARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1962283341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE GRACE HOMECARE LLC

Provider Business Mailing Address
First Line	:	2669 FOREST HILL BLVD STE 211W
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-5937
Country	:	US
Telephone Number	:	561-703-4541
Fax Number	:

Provider Business Practice Location Address
First Line	:	2669 FOREST HILL BLVD STE 211W
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33406-5937
Country	:	US
Telephone Number	:	561-703-4541
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KETYE ETIENNE
Credential	:
Telephone Number	:	561-703-4541

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	10/11/2023

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