MEDICARE: FIDURA & ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	134	VA

General Provider Information

NPI Number	:	1538258421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDURA & ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	7400 BEAUFONT SPRINGS DR STE 403
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5519
Country	:	US
Telephone Number	:	804-560-4640
Fax Number	:	804-560-4813

Provider Business Practice Location Address
First Line	:	7400 BEAUFONT SPRINGS DR STE 403
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5519
Country	:	US
Telephone Number	:	804-560-4640
Fax Number	:	804-560-4813

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JENNIFER G. FIDURA
Credential	:
Telephone Number	:	804-560-4640

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/04/2020

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