Provider Demographics
NPI:1598096604
Name:AFFIANCE HEALTH CARE SERVICES,LLC
Entity Type:Organization
Organization Name:AFFIANCE HEALTH CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRTOR/D.O.N
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUGIATU
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-683-8666
Mailing Address - Street 1:6015 CHESTER CIRCLE STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2265
Mailing Address - Country:US
Mailing Address - Phone:904-683-8666
Mailing Address - Fax:904-683-8672
Practice Address - Street 1:6015 CHESTER CIRCLE STE 104
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2265
Practice Address - Country:US
Practice Address - Phone:904-683-8666
Practice Address - Fax:904-683-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993654251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001433200Medicaid