Healthcare Provider Details

I. General information

NPI: 1174635205
Provider Name (Legal Business Name): FANSI ENDEAVOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8223 SPRING BRANCH CT
LAUREL MD
20723-2031
US

IV. Provider business mailing address

8223 SPRING BRANCH CT
LAUREL MD
20723-2031
US

V. Phone/Fax

Practice location:
  • Phone: 301-317-6073
  • Fax: 301-317-6073
Mailing address:
  • Phone: 301-317-6073
  • Fax: 301-317-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EVELYN VIFANSI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 443-538-6570