Provider Demographics
NPI:1003583733
Name:AFFINITY HEALTHCARE GROUP CHERRY HILL LLC
Entity Type:Organization
Organization Name:AFFINITY HEALTHCARE GROUP CHERRY HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KONNERTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-651-7826
Mailing Address - Street 1:1305 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1919
Mailing Address - Country:US
Mailing Address - Phone:856-651-7826
Mailing Address - Fax:856-229-7142
Practice Address - Street 1:1305 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1919
Practice Address - Country:US
Practice Address - Phone:856-651-7826
Practice Address - Fax:856-229-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone