MEDICARE: AFFINITY AFC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1104562131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY AFC LLC

Provider Business Mailing Address
First Line	:	301 ELLIOT ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02464-1201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 MYSTIC AVE
Second Line	:
City	:	MEDFORD
State	:	MA
Zip	:	02155-4628
Country	:	US
Telephone Number	:	617-777-7050
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VLADISLAV VILKOMIR
Credential	:
Telephone Number	:	617-777-7050

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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Directions to “AFFINITY AFC LLC ” Practice Location

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