Provider Demographics
NPI:1790293488
Name:INFINITY HOPE CENTER LLC
Entity Type:Organization
Organization Name:INFINITY HOPE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:313-613-9392
Mailing Address - Street 1:1759 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1843
Mailing Address - Country:US
Mailing Address - Phone:313-613-9392
Mailing Address - Fax:
Practice Address - Street 1:260 VINEWOOD ST STE 100A8919
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1667
Practice Address - Country:US
Practice Address - Phone:313-315-5145
Practice Address - Fax:313-315-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty