Provider Demographics
NPI:1467414664
Name:INFINITY HOSPICE CARE LLC
Entity Type:Organization
Organization Name:INFINITY HOSPICE CARE LLC
Other - Org Name:INFINITY HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-381-0375
Mailing Address - Street 1:5110 N 40TH ST
Mailing Address - Street 2:STE 107
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2126
Mailing Address - Country:US
Mailing Address - Phone:602-381-0375
Mailing Address - Fax:602-381-0385
Practice Address - Street 1:5110 N 40TH ST
Practice Address - Street 2:STE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2126
Practice Address - Country:US
Practice Address - Phone:602-381-0375
Practice Address - Fax:602-381-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC3842251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
031565Medicare ID - Type Unspecified