Provider Demographics
NPI:1740680636
Name:INFINITY CHRISTIAN COMMUNITY ORGANIZATION
Entity type:Organization
Organization Name:INFINITY CHRISTIAN COMMUNITY ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENZANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-243-4938
Mailing Address - Street 1:1224 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2739
Mailing Address - Country:US
Mailing Address - Phone:414-243-4938
Mailing Address - Fax:
Practice Address - Street 1:6188 N DENMARK ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1644
Practice Address - Country:US
Practice Address - Phone:414-243-4938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management