Provider Demographics
NPI:1427454347
Name:INFINITY CARE HOME HEALTH INC.
Entity type:Organization
Organization Name:INFINITY CARE HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:ROT
Authorized Official - Phone:630-336-5737
Mailing Address - Street 1:210 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-3214
Mailing Address - Country:US
Mailing Address - Phone:630-965-0993
Mailing Address - Fax:
Practice Address - Street 1:210 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3214
Practice Address - Country:US
Practice Address - Phone:630-965-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011674251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011674OtherSTATE LICENSE