Provider Demographics
NPI:1356668412
Name:AFFINITY CARE PROVIDERS INC
Entity Type:Organization
Organization Name:AFFINITY CARE PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-869-6005
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-0580
Mailing Address - Country:US
Mailing Address - Phone:225-869-6005
Mailing Address - Fax:225-869-6007
Practice Address - Street 1:837 N PINE ST
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3659
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:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care