Provider Demographics
NPI:1194148544
Name:AFFIANCE HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:AFFIANCE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-258-1500
Mailing Address - Street 1:2 TERMINAL DR
Mailing Address - Street 2:SUITE 19
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2201
Mailing Address - Country:US
Mailing Address - Phone:618-258-1500
Mailing Address - Fax:618-258-1501
Practice Address - Street 1:2 TERMINAL DR
Practice Address - Street 2:SUITE 19
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2201
Practice Address - Country:US
Practice Address - Phone:618-258-1500
Practice Address - Fax:618-258-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011718251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health