Provider Demographics
NPI:1568736874
Name:INFINITY OF PAGE HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:INFINITY OF PAGE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:928-645-9862
Mailing Address - Street 1:PO BOX 3505
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-3505
Mailing Address - Country:US
Mailing Address - Phone:928-645-6862
Mailing Address - Fax:928-645-9089
Practice Address - Street 1:910 COPPERMINE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-3505
Practice Address - Country:US
Practice Address - Phone:928-645-6862
Practice Address - Fax:928-645-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7076150-000253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ452801Medicaid