Provider Demographics
NPI:1417137597
Name:INFINITY CARE OF MAYWOOD
Entity Type:Organization
Organization Name:INFINITY CARE OF MAYWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-334-8265
Mailing Address - Street 1:6025 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3108
Mailing Address - Country:US
Mailing Address - Phone:323-560-0720
Mailing Address - Fax:323-773-3070
Practice Address - Street 1:6025 PINE AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3108
Practice Address - Country:US
Practice Address - Phone:323-560-0720
Practice Address - Fax:323-773-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000116314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555130Medicare Oscar/Certification