Affinis Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Gainesville, GA
NPI 1184904435 · NPPES record last updated Nov 3, 2023
Key facts
- NPI
- 1184904435
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 069-036-H (GA)
- Legal business name
- AFFINIS HOSPICE, LLC
- Practice address
- 2565 Thompson Bridge Rd
Suite 201
Gainesville, GA 30501-1723 - Phone
- (678) 989-0981
- Fax
- (678) 989-0982
- NPI assigned
- Aug 18, 2011
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sarah A Thompson, RN, CHPN
- Title
- Vice President of Operations
- Phone
- (912) 538-8000
Owners & managing parties with NPI records 1
-
Dave A Ringer, MD
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 4
-
Ashok Kancharla, M.D.
-
Dave A Ringer, MD
Medicare Care Compare: Hospice
- Listed as
- Affinis Hospice, LLC- Gainesville
- Ownership
- Non-Profit
- Certified
- Jan 5, 2012
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2031380 | Affinis Hospice, LLC | Certificate of waiver | Oct 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Hospice certification: CCN 111719
- Legal name
- AFFINIS HOSPICE, LLC
- Doing business as
- AFFINIS HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jan 5, 2012
- Last certification
- Mar 31, 2021
- Ownership / control type
- Non-Profit - Other
- Organization structure
- LLC · Non-profit
- Incorporated
- Jan 4, 2012 in GA
- Enrollment address
- 2565 Thompson Bridge Road
Suite 201
Gainesville, GA 30501-1723
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% |
| Dave a Ringer |
Operational/Managerial Control |
Jul 1, 2025 | 100% |
| Tanya Seabolt |
Corporate Officer |
Feb 1, 2024 | 100% |
| W-2 Managing Employee |
Feb 1, 2024 | 100% | |
| Sarah a Thompson |
Corporate Director |
Feb 14, 2010 | 50% |
| Operational/Managerial Control |
Feb 14, 2010 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111027000730 | GA | Part a Provider - Hospice | 1759579253 | Practice locations: Gainesville, GA |
National Provider Directory
- Tax ID family
- Affinis Hospice
Locations
2816 Evans Mill Rd
Lithonia, GA 30058
Phone (770) 482-2961
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 069-036-H | GA | Yes |
Addresses
Primary practice location
2565 Thompson Bridge Rd
Suite 201
Gainesville, GA 30501-1723
Mailing address
806 Maple Dr
Vidalia, GA 30474-7208
Phone (912) 538-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003122251A | Medicaid | GA |
Other names
- Affinis Hospice
Other providers in Gainesville, GA
- Keith D Adkins
- Lisa Adolf
- Advanced Allergy of North Ga
- Advanced Pain and Rahabilitation PC
- Affiliated Psychological & Medical Consultants, LLC
- Afton M. Burt, PH.D., P.C.
- Folatomi Agbe-Davies
- Olanrewaju Agbe-Davies
- Deepak K Aggarwal
- Chinelo Aghaji
All providers in Gainesville, 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.