Provider Demographics
NPI:1760147045
Name:AFFINITY THERAPY SERVICES
Entity Type:Organization
Organization Name:AFFINITY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-227-0875
Mailing Address - Street 1:5245 EDINA INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2910
Mailing Address - Country:US
Mailing Address - Phone:612-227-0875
Mailing Address - Fax:
Practice Address - Street 1:5245 EDINA INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2910
Practice Address - Country:US
Practice Address - Phone:612-227-0875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health