1710603360 NPI number — INFINITY AND BEYOND HOLISTIC CARE

Table of content: (NPI 1710603360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710603360 NPI number — INFINITY AND BEYOND HOLISTIC CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY AND BEYOND HOLISTIC CARE
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:
1710603360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6462 N LOSEE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89086-0103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 MOUNTAIN SKIES CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89032-8237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-995-4455
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
MUNIRAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-995-4455

Provider Taxonomy Codes

  • Taxonomy code: 320700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1404671583 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com