Provider Demographics
NPI:1326085952
Name:AFFINITY HOSPITAL LLC
Entity Type:Organization
Organization Name:AFFINITY HOSPITAL LLC
Other - Org Name:WOMEN'S HEALTH BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:880 MONTCLAIR RD
Mailing Address - Street 2:SUITE 677
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1972
Mailing Address - Country:US
Mailing Address - Phone:205-599-4673
Mailing Address - Fax:205-599-4724
Practice Address - Street 1:880 MONTCLAIR RD
Practice Address - Street 2:SUITE 677
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1972
Practice Address - Country:US
Practice Address - Phone:205-599-4673
Practice Address - Fax:205-599-4724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPENDING332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942840Medicaid
AL009942840Medicaid