Healthcare Provider Details

I. General information

NPI: 1790420883
Provider Name (Legal Business Name): AFFINITY HOME CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1584 METROPOLITAN BLVD STE 101
TALLAHASSEE FL
32308-1701
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:
Mailing address:
  • Phone: 850-765-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MERLENE D JOHNSON
Title or Position: REGIONAL DIRECTOR
Credential: MASTERS OF EDUCATION
Phone: 850-765-5241