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General NPI Number Information
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NPI Number | 1750825907
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Entity Type | Organization
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Legal Business Name | AFFINITY HOME CARE LLC
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 3720 HAMPTON AVE STE 102A
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City | SAINT LOUIS
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State | MO
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Zip | 63109-1438
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Country | US
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Telephone | 314-744-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 3720 HAMPTON AVE STE 102A
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City | SAINT LOUIS
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State | MO
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Zip | 63109-1438
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Country | US
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Telephone | 314-744-9844
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEYEONTA STEWART
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Credential | BSW,MA
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Telephone | 314-744-9844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | LC001490103
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License Number State | MO
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