Healthcare Provider Details

I. General information

NPI: 1073679205
Provider Name (Legal Business Name): FADMO HEALTH AND HOME CARE AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 TARGEE ST
STATEN ISLAND NY
10304-1926
US

IV. Provider business mailing address

194 TARGEE ST ABBY AGBOOLA
STATEN ISLAND NY
10304-1926
US

V. Phone/Fax

Practice location:
  • Phone: 718-390-0561
  • Fax: 718-390-5166
Mailing address:
  • Phone: 718-390-0561
  • Fax: 718-390-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number403674-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number403674-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number360383-1
License Number StateNY

VIII. Authorized Official

Name: ABBY AGBOOLA
Title or Position: CEO
Credential: CNM
Phone: 718-390-0561