Healthcare Provider Details

I. General information

NPI: 1093806135
Provider Name (Legal Business Name): FIDELITY FIRST HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 MARKET ST SUITE 4
WILMINGTON NC
28403-1453
US

IV. Provider business mailing address

3825 MARKET ST SUITE 4
WILMINGTON NC
28403-1453
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-1003
  • Fax: 910-343-1007
Mailing address:
  • Phone: 910-343-1003
  • Fax: 910-343-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number251E00000X
License Number StateNC

VIII. Authorized Official

Name: MR. DARRYL BROWN
Title or Position: OWNER
Credential:
Phone: 910-279-3245