Provider Demographics
NPI:1396140240
Name:AFFINITY HEALTHCARE
Entity type:Organization
Organization Name:AFFINITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-469-1803
Mailing Address - Street 1:5715 PRINCESS ANNE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VIRGINIA BCH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3222
Mailing Address - Country:US
Mailing Address - Phone:757-962-0748
Mailing Address - Fax:
Practice Address - Street 1:5715 PRINCESS ANNE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:VIRGINIA BCH
Practice Address - State:VA
Practice Address - Zip Code:23462-3222
Practice Address - Country:US
Practice Address - Phone:757-962-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2536261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone