MEDICARE: FIDUS ACHATES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver	TX
2	372500000X	Chore Provider	TX
3	374U00000X	Home Health Aide	TX
4	376J00000X	Homemaker	TX
5	372600000X	Adult Companion	TX

General Provider Information

NPI Number	:	1780113563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDUS ACHATES, INC.

Provider Business Mailing Address
First Line	:	26607 RIDGESTONE PARK LN
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-1282
Country	:	US
Telephone Number	:	281-468-5912
Fax Number	:

Provider Business Practice Location Address
First Line	:	26607 RIDGESTONE PARK LN
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-1282
Country	:	US
Telephone Number	:	281-468-5912
Fax Number	:

Authorized Official
Title or Position	:	CFO/ALTERNATE ADMINISTRATOR
Name	:	KATHEEN SHARON BROWN
Credential	:
Telephone Number	:	832-529-4972

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	07/21/2022

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