Provider Demographics
NPI:1265098339
Name:AFFINITY OF HOPE CARE HOME
Entity type:Organization
Organization Name:AFFINITY OF HOPE CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYODE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEMIMO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:623-414-7715
Mailing Address - Street 1:7518 S 15TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6935
Mailing Address - Country:US
Mailing Address - Phone:623-414-7715
Mailing Address - Fax:
Practice Address - Street 1:7518 S 15TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6935
Practice Address - Country:US
Practice Address - Phone:623-414-7715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances