Provider Demographics
NPI:1114233855
Name:AFFINITY LIFE HEALTHCARE, INC
Entity Type:Organization
Organization Name:AFFINITY LIFE HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-321-0437
Mailing Address - Street 1:1025 AMERICANA LN APT 1027
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7667
Mailing Address - Country:US
Mailing Address - Phone:214-321-0437
Mailing Address - Fax:214-432-2615
Practice Address - Street 1:1025 AMERICANA LN APT 1027
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7667
Practice Address - Country:US
Practice Address - Phone:214-321-0437
Practice Address - Fax:214-432-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization