Provider Demographics
NPI:1134583610
Name:AFFINITY HEALTH MANAGEMENT LLC
Entity type:Organization
Organization Name:AFFINITY HEALTH MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:GERESY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-668-2143
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:OSHTEMO
Mailing Address - State:MI
Mailing Address - Zip Code:49077-0438
Mailing Address - Country:US
Mailing Address - Phone:269-668-2143
Mailing Address - Fax:269-668-4613
Practice Address - Street 1:48288 22ND ST
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9723
Practice Address - Country:US
Practice Address - Phone:269-668-2143
Practice Address - Fax:269-668-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS030369567311ZA0620X
MIAS800237410311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home