Provider Demographics
NPI:1962751388
Name:INFINITE HOLISTIC HEALTH LLC
Entity type:Organization
Organization Name:INFINITE HOLISTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION CONSULTANT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MA, CHC
Authorized Official - Phone:240-388-5396
Mailing Address - Street 1:8103 FAWN CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1947
Mailing Address - Country:US
Mailing Address - Phone:240-388-5396
Mailing Address - Fax:
Practice Address - Street 1:8103 FAWN CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1947
Practice Address - Country:US
Practice Address - Phone:240-388-5396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY59393011133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty