Provider Demographics
NPI:1154739340
Name:INFINITE WAYS NETWORK, INC.
Entity type:Organization
Organization Name:INFINITE WAYS NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMICILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-244-0971
Mailing Address - Street 1:13899 BISCAYNE BLVD STE 223
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1647
Mailing Address - Country:US
Mailing Address - Phone:305-244-0971
Mailing Address - Fax:305-760-2971
Practice Address - Street 1:1400 NE MIAMI GARDENS DR STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33179-4843
Practice Address - Country:US
Practice Address - Phone:305-244-0971
Practice Address - Fax:727-897-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004076900Medicaid