MEDICARE: AFFINITY HOME CARE, 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	253Z00000X	In Home Supportive Care Agency	FA0087497	NM

General Provider Information

NPI Number	:	1124252481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY HOME CARE, LLC

Provider Business Mailing Address
First Line	:	7240 HAWTHORN AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2084
Country	:	US
Telephone Number	:	505-238-9822
Fax Number	:

Provider Business Practice Location Address
First Line	:	7240 HAWTHORN AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2084
Country	:	US
Telephone Number	:	505-238-9822
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	PAUL ANTHONY CHAVEZ
Credential	:
Telephone Number	:	505-238-9822

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	05/14/2009

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