Healthcare Provider Details

I. General information

NPI: 1427784727
Provider Name (Legal Business Name): AFFECTIONATE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17302 CURRAWONG CT
CYPRESS TX
77433-6728
US

IV. Provider business mailing address

17302 CURRAWONG CT
CYPRESS TX
77433-6728
US

V. Phone/Fax

Practice location:
  • Phone: 240-437-1719
  • Fax:
Mailing address:
  • Phone: 240-437-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PETER FLUNG
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-437-1719