Provider Demographics
NPI:1053810440
Name:AFFINITY CARE SOLUTIONS LLC
Entity type:Organization
Organization Name:AFFINITY CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CARE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SELENTRIA
Authorized Official - Middle Name:MIGNON
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:478-256-5143
Mailing Address - Street 1:PO BOX 13778
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-3778
Mailing Address - Country:US
Mailing Address - Phone:478-256-5143
Mailing Address - Fax:
Practice Address - Street 1:564 ROGERS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1740
Practice Address - Country:US
Practice Address - Phone:478-256-5143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X, 251B00000X
GA251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055701657OtherDRIVERS LICENSE