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General NPI Number Information
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NPI Number | 1992990113
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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 | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 3825 MARKET ST SUITE 6
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City | WILMINGTON
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State | NC
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Zip | 28403-1453
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Country | US
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Telephone | 910-343-1003
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 MARKET ST SUITE 6
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City | WILMINGTON
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State | NC
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Zip | 28403-1453
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Country | US
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Telephone | 910-343-1003
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. HENRY JACOBS
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Credential | QP, BA
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Telephone | 910-343-1003
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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 | 251S00000X
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License Number State | NC
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