Provider Demographics
NPI:1982443446
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:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERLENE
Authorized Official - Middle Name:DELOIS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-765-5241
Mailing Address - Street 1:1584 METROPOLITAN BLVD., STE. 101
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-765-5241
Mailing Address - Fax:360-933-2951
Practice Address - Street 1:1584 METROPOLITAN BLVD., STE. 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-765-5241
Practice Address - Fax:360-933-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care