Provider Demographics
NPI:1689851834
Name:AFFINITY HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:AFFINITY HEALTH ASSOCIATES, LLC
Other - Org Name:AFFINITY HEALTH ASSOCIATES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAULBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-332-3330
Mailing Address - Street 1:5421 WRIGHTSVILLE AVE
Mailing Address - Street 2:5421
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6513
Mailing Address - Country:US
Mailing Address - Phone:910-762-6524
Mailing Address - Fax:910-792-1004
Practice Address - Street 1:5421 WRIGHTSVILLE AVE
Practice Address - Street 2:5421
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6513
Practice Address - Country:US
Practice Address - Phone:910-332-3330
Practice Address - Fax:910-792-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0056341041C0700X
NC20010111001207Q00000X
251B00000X
NC200101001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006351Medicaid
NC6006351Medicaid