Provider Demographics
NPI:1376939066
Name:AFFINITY HOME CARE AGENCY, INC.
Entity Type:Organization
Organization Name:AFFINITY HOME CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERLENE
Authorized Official - Middle Name:DELOIS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF BUSINESS
Authorized Official - Phone:850-765-5241
Mailing Address - Street 1:1584 METROPOLITAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1701
Mailing Address - Country:US
Mailing Address - Phone:850-765-5241
Mailing Address - Fax:
Practice Address - Street 1:1731 NW 6TH ST STE A2
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8515
Practice Address - Country:US
Practice Address - Phone:850-345-4806
Practice Address - Fax:360-933-2951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY HOME CARE AGENCY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-09
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 372600000X
FL233632376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005820001Medicaid
FL115511700Medicaid
FL005820000Medicaid