Healthcare Provider Details

I. General information

NPI: 1003400821
Provider Name (Legal Business Name): FIDELITY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 POWDER MILL RD STE 450S-17
BELTSVILLE MD
20705-2675
US

IV. Provider business mailing address

4600 POWDER MILL RD STE 450S-17
BELTSVILLE MD
20705-2675
US

V. Phone/Fax

Practice location:
  • Phone: 240-432-7050
  • Fax: 301-982-3411
Mailing address:
  • Phone: 240-432-7050
  • Fax: 240-523-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BELTTA TACHI
Title or Position: OWNER
Credential: CRNP-PMH
Phone: 240-432-7050