Provider Demographics
NPI:1548817620
Name:AFFINITY RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:AFFINITY RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAHNIA
Authorized Official - Middle Name:AMINAH
Authorized Official - Last Name:HARUT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-386-0942
Mailing Address - Street 1:8053 E BLOOMINGTON FWY STE 500
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1003
Mailing Address - Country:US
Mailing Address - Phone:612-386-0942
Mailing Address - Fax:612-930-0108
Practice Address - Street 1:8053 E BLOOMINGTON FWY STE 500
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1003
Practice Address - Country:US
Practice Address - Phone:952-217-4750
Practice Address - Fax:612-930-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility