MEDICARE: DDP FORTUNA 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	253Z00000X	In Home Supportive Care Agency	03800	NH

General Provider Information

NPI Number	:	1710491808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DDP FORTUNA INC.

Provider Business Mailing Address
First Line	:	1 LIBERTY LN E STE 12
Second Line	:
City	:	HAMPTON
State	:	NH
Zip	:	03842-1839
Country	:	US
Telephone Number	:	603-967-4477
Fax Number	:	603-677-1110

Provider Business Practice Location Address
First Line	:	1 LIBERTY LN E STE 12
Second Line	:
City	:	HAMPTON
State	:	NH
Zip	:	03842-1839
Country	:	US
Telephone Number	:	603-967-4477
Fax Number	:	603-677-1110

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIMBERLY A FORTUNA
Credential	:
Telephone Number	:	603-967-4477

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	11/28/2017

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Directions to “DDP FORTUNA INC. ” Practice Location

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