Affinis Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Vidalia, GA
NPI 1780011528 · NPPES record last updated Feb 22, 2017
Key facts
- NPI
- 1780011528
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- AFFINIS HOSPICE, LLC
- Practice address
- 806 Maple Dr
Vidalia, GA 30474-7208 - Phone
- (912) 538-0465
- Fax
- (912) 538-0467
- NPI assigned
- Oct 10, 2013
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sarah A Thompson, RN, CHPN
- Title
- VP of Operations
- Phone
- (912) 538-8000
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 2
Medicare Care Compare: Hospice
- Listed as
- Affinis Hospice LLC
- Ownership
- For-Profit
- Certified
- Jun 19, 2014
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Hospice certification: CCN 111746
- Legal name
- AFFINIS HOSPICE, LLC
- Doing business as
- AFFINIS HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jun 19, 2014
- Last certification
- Jun 20, 2019
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Non-profit
- Incorporated
- Dec 9, 2009 in GA
- Enrollment address
- 806 Maple Drive
Vidalia, GA 30473-7208
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% |
| Maulikkumar a Patel |
Operational/Managerial Control |
Jul 1, 2025 | 100% |
| Caralyn Louise Johnson |
Corporate Officer |
Feb 1, 2024 | 100% |
| W-2 Managing Employee |
Feb 1, 2024 | 100% | |
| Sarah a Thompson |
Corporate Director |
Feb 14, 2010 | |
| W-2 Managing Employee |
Feb 14, 2010 | ||
| Operational/Managerial Control |
Feb 14, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140404001677 | GA | Part a Provider - Hospice | 1759579253 | Practice locations: Vidalia, GA |
National Provider Directory
- Tax ID family
- Affinis Hospice
Locations
700 E Long St
Claxton, GA 30417
Phone (912) 739-2245
119 Meadows Pkwy W
Vidalia, GA 30474
Phone (912) 230-4539
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
806 Maple Dr
Vidalia, GA 30474-7208
Mailing address
806 Maple Dr
Vidalia, GA 30474-7208
Phone (912) 538-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003152699A | Medicaid | GA | |
| 138-0397-H | Other | GA | STATE LICENSE |
Other names
- Affinis Hospice
Other providers in Vidalia, GA
- Accordia Healthcare LLC
- Brick Acosta
- Abby Virginia Adams
- Ashley Hill Adams
- Air Evac EMS, Inc.
- Regina Lynn Akins
- Jeanie L Allen
- John Benjamin Allen
- Allmond & Whipple, Inc
All providers in Vidalia, 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 Feb 22, 2017. 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.