1013288299 NPI number — AFFINIS HOSPICE, LLC

Table of content: (NPI 1013288299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013288299 NPI number — AFFINIS HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFINIS HOSPICE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AFFINIS HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013288299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 MAPLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIDALIA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30474-7208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-538-0465
Provider Business Mailing Address Fax Number:
912-538-0467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 HIGHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-832-4232
Provider Business Practice Location Address Fax Number:
404-832-4233
Provider Enumeration Date:
01/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
770-475-6540

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 038-0372-H . This is a "STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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