Provider Demographics
NPI:1225424724
Name:AFFINITY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:AFFINITY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIFEREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-298-4023
Mailing Address - Street 1:5951 BULLARD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2824
Mailing Address - Country:US
Mailing Address - Phone:504-298-4023
Mailing Address - Fax:
Practice Address - Street 1:3143 N ROMAN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-6509
Practice Address - Country:US
Practice Address - Phone:510-633-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41769900K253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care