Provider Demographics
NPI:1073679205
Name:FADMO HEALTH AND HOME CARE AGENCY INC
Entity Type:Organization
Organization Name:FADMO HEALTH AND HOME CARE AGENCY INC
Other - Org Name:FADMO HEALTH AND ALLIED SCHOOL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:718-390-0561
Mailing Address - Street 1:194 TARGEE ST
Mailing Address - Street 2:ABBY AGBOOLA
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1926
Mailing Address - Country:US
Mailing Address - Phone:718-390-0561
Mailing Address - Fax:718-390-5166
Practice Address - Street 1:194 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1926
Practice Address - Country:US
Practice Address - Phone:718-390-0561
Practice Address - Fax:718-390-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403674-1251E00000X, 251J00000X
251F00000X, 253Z00000X
NY360383-1385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1343L001Medicaid
NY1343L001OtherCLIA WAIVER
NY1343L001Medicaid
NY1343L001OtherCLIA WAIVER