Provider Demographics
NPI:1275812422
Name:FONDAY SENIORCARE SERVICES
Entity Type:Organization
Organization Name:FONDAY SENIORCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MFON
Authorized Official - Middle Name:NENE
Authorized Official - Last Name:ADEDOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:610-252-7471
Mailing Address - Street 1:2906 WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 211B
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5256
Mailing Address - Country:US
Mailing Address - Phone:610-252-7471
Mailing Address - Fax:610-438-2649
Practice Address - Street 1:2906 WILLIAM PENN HWY
Practice Address - Street 2:SUITE 211B
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5256
Practice Address - Country:US
Practice Address - Phone:610-252-7471
Practice Address - Fax:610-438-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20933601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102598391 0001Medicaid