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General NPI Number Information
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NPI Number | 1538258421
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Entity Type | Organization
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Legal Business Name | FIDURA & ASSOCIATES, INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 7400 BEAUFONT SPRINGS DR STE 403
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23225-5519
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Country | US
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Telephone | 804-560-4640
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Fax | 804-560-4813
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Provider Business Mailing Address
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Address Line | 7400 BEAUFONT SPRINGS DR STE 403
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23225-5519
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Country | US
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Telephone | 804-560-4640
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Fax | 804-560-4813
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JENNIFER G. FIDURA
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Credential |
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Telephone | 804-560-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 134
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License Number State | VA
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