Healthcare Provider Details

I. General information

NPI: 1477964666
Provider Name (Legal Business Name): MRS. CHARLOTTE FITZGERALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PURPLE EMPIRE IN HOME CARE AGENCY

II. Dates (important events)

Enumeration Date: 05/11/2014
Last Update Date: 12/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 BENNOCH RD
OLD TOWN ME
04468-5610
US

IV. Provider business mailing address

2074 BENNOCH RD
OLD TOWN ME
04468-5610
US

V. Phone/Fax

Practice location:
  • Phone: 207-356-3054
  • Fax: 207-817-0197
Mailing address:
  • Phone: 207-356-3054
  • Fax: 207-817-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: