MEDICARE: FUNDAMENTAL HEALTH AND COMMUNITY DEVELOPMENT SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WC1500X	Community Health Registered Nurse
2	251B00000X	Case Management Agency
3	253Z00000X	In Home Supportive Care Agency
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1881997260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNDAMENTAL HEALTH AND COMMUNITY DEVELOPMENT SERVICES

Provider Business Mailing Address
First Line	:	1840 W. 5TH ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417
Country	:	US
Telephone Number	:	937-469-8524
Fax Number	:	937-637-2035

Provider Business Practice Location Address
First Line	:	1840 W. 5TH ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417
Country	:	US
Telephone Number	:	937-469-8524
Fax Number	:	937-637-2035

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MONDORA F TINGLE
Credential	:	RN
Telephone Number	:	937-469-8524

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	06/04/2021

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