Healthcare Provider Details

I. General information

NPI: 1811669898
Provider Name (Legal Business Name): FIDEM CARE SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5317 ANHINGA TRL
NEW PORT RICHEY FL
34653-7032
US

IV. Provider business mailing address

5317 ANHINGA TRL
NEW PORT RICHEY FL
34653-7032
US

V. Phone/Fax

Practice location:
  • Phone: 727-320-2708
  • Fax:
Mailing address:
  • Phone: 727-320-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: TASHYRA DASH
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 727-320-2708