Provider Demographics
NPI:1295390995
Name:INFINITY GROUP HOME LLC
Entity Type:Organization
Organization Name:INFINITY GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REKETA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-568-4126
Mailing Address - Street 1:117 PARADISE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-5028
Mailing Address - Country:US
Mailing Address - Phone:205-568-4126
Mailing Address - Fax:205-434-4441
Practice Address - Street 1:1412 CAHABA RIVER PARC
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3269
Practice Address - Country:US
Practice Address - Phone:205-568-4126
Practice Address - Fax:205-434-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health