Provider Demographics
NPI:1316998974
Name:AFFINITY HOME CARE AGENCY INC
Entity type:Organization
Organization Name:AFFINITY HOME CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZAYID
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-245-3392
Mailing Address - Street 1:2569 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3555
Mailing Address - Country:US
Mailing Address - Phone:248-363-8650
Mailing Address - Fax:248-363-8652
Practice Address - Street 1:2569 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3555
Practice Address - Country:US
Practice Address - Phone:248-363-8650
Practice Address - Fax:248-363-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE 995OtherBLUE CROSS
MI237619Medicare ID - Type Unspecified