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General NPI Number Information
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NPI Number | 1043586894
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Entity Type | Organization
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Legal Business Name | AFFINITY SUPPORTIVE HEALTHCARE SERVICES LLC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 2100 BROADWAY AVE
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City | HARVEY
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State | LA
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Zip | 70058-3220
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Country | US
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Telephone | 504-638-1273
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Fax |
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Provider Business Mailing Address
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Address Line | 14576 BEEKMAN RD
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City | NEW ORLEANS
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State | LA
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Zip | 70128-2106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | TRIMEKIA WARE
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Credential |
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Telephone | 504-638-1273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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