Provider Demographics
NPI:1164128211
Name:INFINITE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:INFINITE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:318-812-4565
Mailing Address - Street 1:66 BAYOU VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2732
Mailing Address - Country:US
Mailing Address - Phone:318-812-4565
Mailing Address - Fax:
Practice Address - Street 1:66 BAYOU VIEW DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2732
Practice Address - Country:US
Practice Address - Phone:318-812-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1632671Medicaid