Provider Demographics
NPI:1639542699
Name:AFFINITY HEALTH CENTER
Entity Type:Organization
Organization Name:AFFINITY HEALTH CENTER
Other - Org Name:AFFINITY HEALTH CENTER FORT MILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:803-909-9710
Mailing Address - Street 1:455 LAKESHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 ELLIOTT ST E
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-1848
Practice Address - Country:US
Practice Address - Phone:803-909-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-12
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
SC42-1036261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC193Medicaid