Provider Demographics
NPI:1184025363
Name:INFINITI HOSPICE
Entity Type:Organization
Organization Name:INFINITI HOSPICE
Other - Org Name:INFINITI HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-382-6067
Mailing Address - Street 1:13919 HOLLOWGREEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1825
Mailing Address - Country:US
Mailing Address - Phone:713-382-6067
Mailing Address - Fax:
Practice Address - Street 1:13919 HOLLOWGREEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1825
Practice Address - Country:US
Practice Address - Phone:713-382-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based