Provider Demographics
NPI:1811495724
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:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERLENE
Authorized Official - Middle Name:DELOIS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF BUSINESS
Authorized Official - Phone:850-765-5241
Mailing Address - Street 1:1584 METROPOLITAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1701
Mailing Address - Country:US
Mailing Address - Phone:850-765-5241
Mailing Address - Fax:360-933-2951
Practice Address - Street 1:250 INTERNATIONAL PKWY STE 134
Practice Address - Street 2:
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-5044
Practice Address - Country:US
Practice Address - Phone:850-765-5241
Practice Address - Fax:360-933-2951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFINITY HOME CARE AGENCY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-25
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234961253Z00000X
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
FL234962Medicaid
FL233632Medicaid
FL234961Medicaid