Provider Demographics
NPI:1962283341
Name:INFINITE GRACE HOMECARE LLC
Entity type:Organization
Organization Name:INFINITE GRACE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KETYE
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-703-4541
Mailing Address - Street 1:2669 FOREST HILL BLVD STE 211W
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5937
Mailing Address - Country:US
Mailing Address - Phone:561-703-4541
Mailing Address - Fax:
Practice Address - Street 1:2669 FOREST HILL BLVD STE 211W
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-5937
Practice Address - Country:US
Practice Address - Phone:561-703-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health