Provider Demographics
NPI:1528011707
Name:AFFINITY HOME HEALTH SERVICES, LLC.
Entity Type:Organization
Organization Name:AFFINITY HOME HEALTH SERVICES, LLC.
Other - Org Name:AT HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TCRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-933-1936
Mailing Address - Street 1:2721 E RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2426
Mailing Address - Country:US
Mailing Address - Phone:702-933-1936
Mailing Address - Fax:702-946-6670
Practice Address - Street 1:2721 E RUSSELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2426
Practice Address - Country:US
Practice Address - Phone:702-933-1936
Practice Address - Fax:702-946-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV253334251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV253334OtherNEVADA STATE BUSINESS LIC
NV253334OtherNEVADA STATE BUSINESS LIC