Healthcare Provider Details

I. General information

NPI: 1619794666
Provider Name (Legal Business Name): AFFLUENT HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W 24TH AVE
CORDELE GA
31015-3941
US

IV. Provider business mailing address

411 W 24TH AVE 411 W 24TH AVE
CORDELE GA
31015-3941
US

V. Phone/Fax

Practice location:
  • Phone: 229-715-7225
  • Fax:
Mailing address:
  • Phone: 229-715-7225
  • Fax: 229-513-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KEYONDRA CLARK
Title or Position: ADMINISTRATOR
Credential:
Phone: 229-715-7225