Provider Demographics
NPI:1750825907
Name:AFFINITY HOME CARE LLC
Entity Type:Organization
Organization Name:AFFINITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEYEONTA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:BSW,MA
Authorized Official - Phone:314-744-9844
Mailing Address - Street 1:3720 HAMPTON AVE STE 102A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1438
Mailing Address - Country:US
Mailing Address - Phone:314-744-9844
Mailing Address - Fax:
Practice Address - Street 1:3720 HAMPTON AVE STE 102A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1438
Practice Address - Country:US
Practice Address - Phone:314-744-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001490103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health