Provider Demographics
NPI:1821523192
Name:INFINITY GROUPS HOMES LLC
Entity Type:Organization
Organization Name:INFINITY GROUPS HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOZAMIL
Authorized Official - Middle Name:GABIR
Authorized Official - Last Name:ABDELRAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-907-4474
Mailing Address - Street 1:15111 N 33RD PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4552
Mailing Address - Country:US
Mailing Address - Phone:480-907-4474
Mailing Address - Fax:
Practice Address - Street 1:15111 N 33RD PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4552
Practice Address - Country:US
Practice Address - Phone:480-907-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5141251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health