Provider Demographics
NPI:1609408020
Name:AFFINITY TELEHEALTH LLC
Entity Type:Organization
Organization Name:AFFINITY TELEHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:248-565-7169
Mailing Address - Street 1:3 WOLFE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4342
Mailing Address - Country:US
Mailing Address - Phone:248-565-7169
Mailing Address - Fax:248-278-4868
Practice Address - Street 1:3 WOLFE LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-4342
Practice Address - Country:US
Practice Address - Phone:248-565-7169
Practice Address - Fax:248-278-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service