1528762168 NPI number — INFINITE HEART, INC.

Table of content: (NPI 1528762168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528762168 NPI number — INFINITE HEART, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITE HEART, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528762168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6450 DOUBLE EAGLE DR APT 505
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODRIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60517-1598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-751-3306
Provider Business Mailing Address Fax Number:
855-634-2217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 E BOUGHTON RD STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLINGBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60440-2257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-751-3306
Provider Business Practice Location Address Fax Number:
855-634-2217
Provider Enumeration Date:
03/28/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PECK
Authorized Official First Name:
ERIK
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
815-751-3306

Provider Taxonomy Codes

  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)