Affinis Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Newnan, GA
NPI 1013288299 · NPPES record last updated Nov 3, 2023
Key facts
- NPI
- 1013288299
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- AFFINIS HOSPICE, LLC
- Practice address
- 21 Highland Dr
Newnan, GA 30265-1738 - Phone
- (404) 832-4232
- Fax
- (404) 832-4233
- NPI assigned
- Jan 20, 2012
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sarah A Thompson, RN, CHPN
- Title
- Director of Operations
- Phone
- (770) 475-6540
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 10
Member of 1
Facilities with the same owner 11
Affiliated clinicians 3
-
David Edgar Vann, M.D.
Medicare Care Compare: Hospice
- Listed as
- Affinis Hospice
- Ownership
- For-Profit
- Certified
- Sep 27, 2012
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2053487 | Affinis Hospice, LLC | Certificate of waiver | Jan 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Hospice certification: CCN 111728
- Legal name
- AFFINIS HOSPICE, LLC
- Doing business as
- AFFINIS HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Sep 27, 2012
- Last certification
- Sep 9, 2021
- Ownership / control type
- Non-Profit - Private
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 9, 2009 in GA
- Enrollment address
- 21 Highland Drive
Newnan, GA 30265-1738
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Home and Community Services Inc |
5% Or Greater Direct Ownership Interest | Jan 1, 2021 | 100% |
| Wyatt K Blake |
Operational/Managerial Control |
Jan 1, 2026 | 100% |
| Amy Tomlin |
Corporate Director |
May 13, 2019 | 100% |
| Sarah a Thompson |
Corporate Director | Jan 1, 2012 | |
| W-2 Managing Employee | Jan 1, 2012 | ||
| Operational/Managerial Control | Jan 1, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120329000487 | GA | Part a Provider - Hospice | 1759579253 | Practice locations: Newnan, GA |
National Provider Directory
- Tax ID family
- Affinis Hospice
Locations
4080 McGinnis Ferry Rd
Ste 804
Alpharetta, GA 30005
946 Veterans Pkwy
Barnesville, GA 30204
Phone (770) 358-2485
21 Highland Dr
Newnan, GA 30265
Phone (404) 832-4232
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
21 Highland Dr
Newnan, GA 30265-1738
Mailing address
806 Maple Dr
Vidalia, GA 30474-7208
Phone (912) 538-0465
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 038-0372-H | Other | GA | STATE LICENSE |
Other names
- Affinis Hospice
Other providers in Newnan, GA
- Ibrahim Wiah Adamu
- Olufunsho Adekunle
- Bamidele A Adesunloye
- Advanced Health and Wellness Center, Inc.
- Aegis Group Practice LLC
- Affordable Dentures & Implants - Newnan, P.C.
- Affordable Dentures & Implants of Georgia II, LLC
- Affordable Dentures & Implants of Georgia V, LLC
- African American Task Force for Substance Abuse Prevention
- After the Fall Inc.
All providers in Newnan, GA · Community Based Hospice Care Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.