Provider Demographics
NPI:1093535882
Name:INFINITY LLC
Entity type:Organization
Organization Name:INFINITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBU MBENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MHRTC DSP
Authorized Official - Phone:207-347-9614
Mailing Address - Street 1:605 US ROUTE 1 STE 9
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9617
Mailing Address - Country:US
Mailing Address - Phone:207-347-9614
Mailing Address - Fax:508-546-8128
Practice Address - Street 1:605 US ROUTE 1 STE 9
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9617
Practice Address - Country:US
Practice Address - Phone:207-347-9614
Practice Address - Fax:508-546-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health