Healthcare Provider Details

I. General information

NPI: 1730721374
Provider Name (Legal Business Name): AFFINITY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 15TH ST SUITE 8
GULFPORT MS
39501
US

IV. Provider business mailing address

1822 15TH ST SUITE 8
GULFPORT MS
39501
US

V. Phone/Fax

Practice location:
  • Phone: 228-233-3574
  • Fax: 228-233-3576
Mailing address:
  • Phone: 228-233-3574
  • Fax: 228-233-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ANGELA CARTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 228-233-3574