Provider Demographics
NPI:1669171427
Name:AFFINITY CARE LLC
Entity type:Organization
Organization Name:AFFINITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNECHIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-287-4827
Mailing Address - Street 1:9095 CABRERA COVE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-3226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 E BONANZA RD STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3705
Practice Address - Country:US
Practice Address - Phone:714-287-4827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care