Provider Demographics
NPI:1760259295
Name:INFINITY HOUSING SERVICE
Entity Type:Organization
Organization Name:INFINITY HOUSING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDETA
Authorized Official - Middle Name:
Authorized Official - Last Name:TULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-229-1635
Mailing Address - Street 1:2913 RICE CREEK PKWY NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6766
Mailing Address - Country:US
Mailing Address - Phone:612-229-1635
Mailing Address - Fax:
Practice Address - Street 1:2913 RICE CREEK PKWY NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55449-6766
Practice Address - Country:US
Practice Address - Phone:612-229-1635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No305R00000XManaged Care OrganizationsPreferred Provider Organization