Healthcare Provider Details

I. General information

NPI: 1962888529
Provider Name (Legal Business Name): AFFINITY HOME CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 42ND SQUARE
VERO BEACH FL
32967
US

IV. Provider business mailing address

4070 42ND SQUARE
VERO BEACH FL
32967-3902
US

V. Phone/Fax

Practice location:
  • Phone: 850-345-4806
  • Fax:
Mailing address:
  • Phone: 850-345-4806
  • 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 Number372600000X
License Number StateFL

VIII. Authorized Official

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