Provider Demographics
NPI:1013361294
Name:INFINITY BEHAVIORAL SYSTEMS LLC
Entity Type:Organization
Organization Name:INFINITY BEHAVIORAL SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:BA,MSW,MBA
Authorized Official - Phone:574-204-2935
Mailing Address - Street 1:1318 MISHAWAKA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3919
Mailing Address - Country:US
Mailing Address - Phone:574-204-2935
Mailing Address - Fax:574-387-4794
Practice Address - Street 1:1318 MISHAWAKA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3919
Practice Address - Country:US
Practice Address - Phone:574-204-2935
Practice Address - Fax:574-387-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health