Healthcare Provider Details

I. General information

NPI: 1679335533
Provider Name (Legal Business Name): AFFINITY CARE OF CHARLOTTE AND DESOTO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18501 MURDOCK CIR STE 103
PORT CHARLOTTE FL
33948-4002
US

IV. Provider business mailing address

18501 MURDOCK CIR STE 103
PORT CHARLOTTE FL
33948-4002
US

V. Phone/Fax

Practice location:
  • Phone: 941-336-5001
  • Fax: 941-870-6637
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL STERN
Title or Position: CEO
Credential:
Phone: 510-499-9977