Provider Demographics
NPI:1528601911
Name:INFINITE LOVE HOSPICE CARE LLC
Entity Type:Organization
Organization Name:INFINITE LOVE HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-462-6800
Mailing Address - Street 1:4950 N 7TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2406
Mailing Address - Country:US
Mailing Address - Phone:480-462-6800
Mailing Address - Fax:480-535-1626
Practice Address - Street 1:4950 N 7TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2406
Practice Address - Country:US
Practice Address - Phone:480-462-6800
Practice Address - Fax:480-535-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005714Medicaid