MEDICARE: FISCALLY RESPONSIBLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	251X00000X	Supports Brokerage Agency
3	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1679192421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISCALLY RESPONSIBLE LLC

Provider Business Mailing Address
First Line	:	175 ELMWOOD DR
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-1129
Country	:	US
Telephone Number	:	973-380-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 ELMWOOD DR
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-1129
Country	:	US
Telephone Number	:	973-380-2215
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRITTANY CHARLES
Credential	:
Telephone Number	:	973-380-2215

Provider Enumeration Date	:	04/12/2020
Last Update Date	:	04/12/2020

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