Provider Demographics
NPI:1780011528
Name:AFFINIS HOSPICE, LLC
Entity Type:Organization
Organization Name:AFFINIS HOSPICE, LLC
Other - Org Name:AFFINIS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CHPN
Authorized Official - Phone:912-538-8000
Mailing Address - Street 1:806 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-7208
Mailing Address - Country:US
Mailing Address - Phone:912-538-8000
Mailing Address - Fax:912-538-0467
Practice Address - Street 1:806 MAPLE DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7208
Practice Address - Country:US
Practice Address - Phone:912-538-0465
Practice Address - Fax:912-538-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003152699AMedicaid
GA138-0397-HOtherSTATE LICENSE