Provider Demographics
NPI:1164606182
Name:AFFINITY CARE PROVIDERS, INC.
Entity Type:Organization
Organization Name:AFFINITY CARE PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM.
Authorized Official - Prefix:MS
Authorized Official - First Name:STARLETTE
Authorized Official - Middle Name:SABRINA
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-869-6005
Mailing Address - Street 1:P O BOX 580
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052
Mailing Address - Country:US
Mailing Address - Phone:225-869-6005
Mailing Address - Fax:225-869-6007
Practice Address - Street 1:837 N. PINE STREET STE. C
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052
Practice Address - Country:US
Practice Address - Phone:225-869-6005
Practice Address - Fax:225-869-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1509442251S00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1509442Medicaid