=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073679205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FADMO HEALTH AND HOME CARE AGENCY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2006
-----------------------------------------------------
Last Update Date | 03/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 194 TARGEE ST
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-390-0561
-----------------------------------------------------
Fax | 718-390-5166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 194 TARGEE ST ABBY AGBOOLA
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-390-0561
-----------------------------------------------------
Fax | 718-390-5166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ABBY AGBOOLA
-----------------------------------------------------
Credential | CNM
-----------------------------------------------------
Telephone | 718-390-0561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 403674-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | 360383-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 403674-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------