Provider Demographics
NPI:1326588112
Name:6812 MCCORMICK RD. UPPER MARLBORO MD. 20772
Entity Type:Organization
Organization Name:6812 MCCORMICK RD. UPPER MARLBORO MD. 20772
Other - Org Name:FIDELT QUALITY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:FIDELIA
Authorized Official - Middle Name:YAA
Authorized Official - Last Name:TUFUOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-274-4794
Mailing Address - Street 1:6812 MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4351
Mailing Address - Country:US
Mailing Address - Phone:240-274-4794
Mailing Address - Fax:
Practice Address - Street 1:6812 MCCORMICK RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4351
Practice Address - Country:US
Practice Address - Phone:240-274-4794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R3967
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3967251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53001440-00Medicaid