Provider Demographics
NPI:1639743545
Name:AFFINITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:AFFINITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDULLAHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-876-2884
Mailing Address - Street 1:1405 SILVER LAKE RD NW STE 18
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-9312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1405 SILVER LAKE RD NW STE 18
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-9312
Practice Address - Country:US
Practice Address - Phone:612-876-2884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY SUPPORT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health