=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790574630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFINITY HOME CARE AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2025
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1945 17TH ST UNIT A
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34234-7520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-765-5241
-----------------------------------------------------
Fax | 360-933-2951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1584 METROPOLITAN BLVD STE 101
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-765-5241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. MERLENE DELOIS JOHNSON
-----------------------------------------------------
Credential | MASTERS OF EDUCATION
-----------------------------------------------------
Telephone | 850-765-5241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------