Healthcare Provider Details

I. General information

NPI: 1790574630
Provider Name (Legal Business Name): AFFINITY HOME CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 17TH ST UNIT A
SARASOTA FL
34234-7520
US

IV. Provider business mailing address

1584 METROPOLITAN BLVD STE 101
TALLAHASSEE FL
32308-1701
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

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