Healthcare Provider Details

I. General information

NPI: 1376939066
Provider Name (Legal Business Name): AFFINITY HOME CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 NW 6TH ST STE A2
GAINESVILLE FL
32609-8515
US

IV. Provider business mailing address

1584 METROPOLITAN BLVD STE 101
TALLAHASSEE FL
32308-1701
US

V. Phone/Fax

Practice location:
  • Phone: 850-345-4806
  • Fax: 360-933-2951
Mailing address:
  • Phone: 850-765-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number233632
License Number StateFL

VIII. Authorized Official

Name: MERLENE DELOIS JOHNSON
Title or Position: DIRECTOR
Credential: MASTERS OF BUSINESS
Phone: 850-765-5241