Provider Demographics
NPI:1003400821
Name:FIDELITY HEALTH CARE LLC
Entity Type:Organization
Organization Name:FIDELITY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELTTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TACHI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:240-432-7050
Mailing Address - Street 1:7501 GREENWAY CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3544
Mailing Address - Country:US
Mailing Address - Phone:240-432-7050
Mailing Address - Fax:240-523-9282
Practice Address - Street 1:7501 GREENWAY CENTER DR STE 450
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3544
Practice Address - Country:US
Practice Address - Phone:240-432-7050
Practice Address - Fax:240-523-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty