Provider Demographics
NPI:1275852220
Name:INFINITY ONE CORPORATION, INC.
Entity Type:Organization
Organization Name:INFINITY ONE CORPORATION, INC.
Other - Org Name:INFINITY ONE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:803-796-9612
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0362
Mailing Address - Country:US
Mailing Address - Phone:803-796-9612
Mailing Address - Fax:803-796-9615
Practice Address - Street 1:3935 SUNSET BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-796-9612
Practice Address - Fax:803-796-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC58383251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management