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General NPI Number Information
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NPI Number | 1114241874
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Entity Type | Organization
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Legal Business Name | FIDELITY FIRST HEALTH CARE SERVICES, LLC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 4000 GUS YOUNG AVE SUITE 104
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City | BATON ROUGE
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State | LA
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Zip | 70802-1700
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Country | US
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Telephone | 225-388-9843
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 GUS YOUNG AVE SUITE 104
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City | BATON ROUGE
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State | LA
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Zip | 70802-1700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DARRYL BROWN
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Credential |
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Telephone | 910-262-3309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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