Provider Demographics
NPI:1134768138
Name:INFINITE HEART HOSPICE LLC
Entity type:Organization
Organization Name:INFINITE HEART HOSPICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-205-3666
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-0670
Mailing Address - Country:US
Mailing Address - Phone:661-205-3666
Mailing Address - Fax:
Practice Address - Street 1:500 S CHINOWTH ST STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-1653
Practice Address - Country:US
Practice Address - Phone:559-409-7500
Practice Address - Fax:559-409-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based