Provider Demographics
NPI:1609455450
Name:AFFINITY PALLIATIVE OF VIRGINIA LLC
Entity Type:Organization
Organization Name:AFFINITY PALLIATIVE OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-499-9977
Mailing Address - Street 1:714 THIMBLE SHOALS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2574
Mailing Address - Country:US
Mailing Address - Phone:757-330-8050
Mailing Address - Fax:757-952-2656
Practice Address - Street 1:714 THIMBLE SHOALS BLVD STE C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2574
Practice Address - Country:US
Practice Address - Phone:757-330-8050
Practice Address - Fax:757-952-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty