Healthcare Provider Details

I. General information

NPI: 1053810440
Provider Name (Legal Business Name): AFFINITY CARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 ROGERS DR
MACON GA
31204-1740
US

IV. Provider business mailing address

PO BOX 13778
MACON GA
31208-3778
US

V. Phone/Fax

Practice location:
  • Phone: 478-256-5143
  • Fax:
Mailing address:
  • Phone: 478-256-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS SELENTRIA MIGNON KENDRICK
Title or Position: OWNER/CARE MANAGER
Credential: MS
Phone: 478-256-5143