Provider Demographics
NPI:1811650617
Name:INFINITY TREATMENT CENTERS OF AMERICA LLC
Entity type:Organization
Organization Name:INFINITY TREATMENT CENTERS OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOINUDDIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MUTTAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-220-2238
Mailing Address - Street 1:790 TURNPIKE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6129
Mailing Address - Country:US
Mailing Address - Phone:678-296-0842
Mailing Address - Fax:803-932-9618
Practice Address - Street 1:790 TURNPIKE ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6129
Practice Address - Country:US
Practice Address - Phone:678-296-0842
Practice Address - Fax:803-932-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)