Provider Demographics
NPI:1073011680
Name:INFINITY GROUPS HOMES LLC
Entity Type:Organization
Organization Name:INFINITY GROUPS HOMES LLC
Other - Org Name:INFINITY GROUPS HOMES 3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TADAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-330-0357
Mailing Address - Street 1:15111 N 33RD PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4552
Mailing Address - Country:US
Mailing Address - Phone:480-907-4474
Mailing Address - Fax:
Practice Address - Street 1:2146 E EVERETT DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4153
Practice Address - Country:US
Practice Address - Phone:480-907-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5326251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health