Provider Demographics
NPI:1184136145
Name:INFINITE SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:INFINITE SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEPORSHIA
Authorized Official - Middle Name:ARVETTA
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-986-7557
Mailing Address - Street 1:1345 N GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3811
Mailing Address - Country:US
Mailing Address - Phone:407-986-7557
Mailing Address - Fax:352-504-4354
Practice Address - Street 1:1345 N GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3811
Practice Address - Country:US
Practice Address - Phone:407-986-7557
Practice Address - Fax:352-504-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 3747A0650X, 385H00000X, 174200000X
FL253Z00000X
FL23940372500000X, 372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174200000XOther Service ProvidersMeals
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023916300Medicaid
FL024187700Medicaid
FL1477058832Medicaid