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General NPI Number Information
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NPI Number | 1730461013
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Entity Type | Organization
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Legal Business Name | AFFINITY HOME CARE, INC
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 205 CARTER ST
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City | VIDALIA
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State | LA
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Zip | 71373-3303
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Country | US
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Telephone | 318-336-3300
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Fax | 318-336-9005
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Provider Business Mailing Address
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Address Line | PO BOX 1215
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City | VIDALIA
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State | LA
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Zip | 71373-1215
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Country | US
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Telephone | 318-336-3300
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Fax | 318-336-9005
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JOSEPHINE J HAWKINS
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Credential | R.N.
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Telephone | 318-336-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | PCA 15521
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License Number State | LA
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