Provider Demographics
NPI:1609917467
Name:AFFECTIONATE HOME HEALTHCARE INCORPORATED
Entity Type:Organization
Organization Name:AFFECTIONATE HOME HEALTHCARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:FENDERSON
Authorized Official - Last Name:BODDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-212-5922
Mailing Address - Street 1:PO BOX 2531
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2531
Mailing Address - Country:US
Mailing Address - Phone:252-212-5922
Mailing Address - Fax:252-212-5922
Practice Address - Street 1:6635 BULLOCK SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27802-2531
Practice Address - Country:US
Practice Address - Phone:252-212-5922
Practice Address - Fax:252-212-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2407251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600990Medicaid