Provider Demographics
NPI:1477058832
Name:INFINITE SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:INFINITE SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEPORSHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-346-0831
Mailing Address - Street 1:129 GROVE RIDGE CIRCLE
Mailing Address - Street 2:104
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:352-346-0831
Mailing Address - Fax:407-814-2003
Practice Address - Street 1:3116 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ZELLWOOD
Practice Address - State:FL
Practice Address - Zip Code:32798-9661
Practice Address - Country:US
Practice Address - Phone:352-346-0831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals