=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669924197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFINTY AT HOME, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2016
-----------------------------------------------------
Last Update Date | 11/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2317 S 24TH ST
-----------------------------------------------------
City | LEAVENWORTH
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66048-6549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-744-4945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2317 S 24TH ST
-----------------------------------------------------
City | LEAVENWORTH
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66048-6549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-744-4945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF ADMINISTRATION
-----------------------------------------------------
Name | VIRGINIA M CRAIG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-744-4945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------