Healthcare Provider Details

I. General information

NPI: 1396140240
Provider Name (Legal Business Name): AFFINITY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 PRINCESS ANNE RD SUITE 107
VIRGINIA BCH VA
23462-3222
US

IV. Provider business mailing address

5715 PRINCESS ANNE RD SUITE 107
VIRGINIA BCH VA
23462-3222
US

V. Phone/Fax

Practice location:
  • Phone: 757-962-0748
  • Fax:
Mailing address:
  • Phone: 757-962-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number2536
License Number StateVA

VIII. Authorized Official

Name: MRS. SHEILAH MAXWELL
Title or Position: PHARMACIST IN CHARGE
Credential: R.PH
Phone: 757-469-1803