Healthcare Provider Details

I. General information

NPI: 1497455893
Provider Name (Legal Business Name): FIDELITY ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ANDERSON AVE
WESTBROOK ME
04092-4003
US

IV. Provider business mailing address

35 ANDERSON AVE
WESTBROOK ME
04092-4003
US

V. Phone/Fax

Practice location:
  • Phone: 207-653-7565
  • Fax:
Mailing address:
  • Phone: 207-653-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK BIREGEYA
Title or Position: CEO
Credential:
Phone: 207-653-7565