Provider Demographics
NPI:1982037461
Name:AFFINITY HOME CARE AGENCY, INC.
Entity Type:Organization
Organization Name:AFFINITY HOME CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:JONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-765-5241
Mailing Address - Street 1:3301 SW 13TH ST
Mailing Address - Street 2:APT. Y330
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3029
Mailing Address - Country:US
Mailing Address - Phone:850-980-4779
Mailing Address - Fax:
Practice Address - Street 1:1584 METROPOLITAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-765-5241
Practice Address - Fax:360-933-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232545253Z00000X
372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005820001Medicaid
FL005820000Medicaid