Healthcare Provider Details

I. General information

NPI: 1225861750
Provider Name (Legal Business Name): FIDELIS COMMUNITY SERVICES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9580 56TH AVE APT A
HUDSONVILLE MI
49426-7303
US

IV. Provider business mailing address

1971 E BELTLINE AVE NE # 106-1868
GRAND RAPIDS MI
49525-7045
US

V. Phone/Fax

Practice location:
  • Phone: 774-203-9430
  • Fax:
Mailing address:
  • Phone: 774-203-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ELIUD MAINA
Title or Position: PRESIDENT
Credential:
Phone: 774-203-9430