Healthcare Provider Details

I. General information

NPI: 1497945661
Provider Name (Legal Business Name): FIDELITY CARE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 POLK ST
HOLLYWOOD FL
33020-4539
US

IV. Provider business mailing address

2001 POLK ST
HOLLYWOOD FL
33020-4539
US

V. Phone/Fax

Practice location:
  • Phone: 954-927-2001
  • Fax: 954-927-2001
Mailing address:
  • Phone: 954-927-2001
  • Fax: 954-927-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL6508
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL6508
License Number StateFL

VIII. Authorized Official

Name: MRS. GLADYS VALDEZ
Title or Position: OWNER
Credential:
Phone: 954-927-2001