Healthcare Provider Details

I. General information

NPI: 1205675824
Provider Name (Legal Business Name): AFFINITY HOME CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/25/2024
Certification Date: 05/25/2024
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: 360-933-2951
Mailing address:
  • Phone: 850-765-5241
  • Fax: 360-933-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MERLENE DELOIS JOHNSON
Title or Position: DIRECTOR
Credential: MD
Phone: 850-765-5241