Provider Demographics
NPI:1891755393
Name:AFFILIA HOME HEALTH
Entity Type:Organization
Organization Name:AFFILIA HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-544-2190
Mailing Address - Street 1:PO BOX 10788
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17605-0788
Mailing Address - Country:US
Mailing Address - Phone:717-397-8251
Mailing Address - Fax:717-397-8666
Practice Address - Street 1:1811 OLDE HOMESTEAD LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5800
Practice Address - Country:US
Practice Address - Phone:717-397-8251
Practice Address - Fax:717-397-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA701305251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1509024OtherGATEWAY HEALTH PLAN
0005052000OtherINDEPENDENCE BLUE CROSS
PA1007620040007Medicaid
PA1007620040007Medicaid