Healthcare Provider Details

I. General information

NPI: 1801322664
Provider Name (Legal Business Name): FORTUNE HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 GREENBELT RD
BERWYN HEIGHTS MD
20740-2352
US

IV. Provider business mailing address

6321 GREENBELT RD
BERWYN HEIGHTS MD
20740-2352
US

V. Phone/Fax

Practice location:
  • Phone: 202-714-7526
  • Fax: 301-249-9627
Mailing address:
  • Phone: 202-714-7526
  • Fax: 301-249-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR3778
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4237609-00
License Number StateMD

VIII. Authorized Official

Name: MS. OBELEBRA BRIGGS
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 202-714-7526