Healthcare Provider Details

I. General information

NPI: 1437020708
Provider Name (Legal Business Name): FIDELITY PRIME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-128 ORCHIDLAND DRIVE
KEAAU HI
96749
US

IV. Provider business mailing address

PO BOX 7129 202
HILO HI
96720-8939
US

V. Phone/Fax

Practice location:
  • Phone: 808-934-4950
  • Fax: 807-769-4817
Mailing address:
  • Phone: 808-934-4950
  • Fax: 808-769-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA MACADANGDANG
Title or Position: CORPORATE TREASURER
Credential:
Phone: 808-934-4950