Healthcare Provider Details

I. General information

NPI: 1154195402
Provider Name (Legal Business Name): FATASHHEALTHCARE LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 S 61ST ST # A
TEMPLE TX
76504-6823
US

IV. Provider business mailing address

2123 S 61ST ST # A
TEMPLE TX
76504-6823
US

V. Phone/Fax

Practice location:
  • Phone: 862-588-8065
  • Fax:
Mailing address:
  • Phone: 862-588-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: FATI ADAMU
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 862-588-8065