Provider Demographics
NPI:1497945661
Name:FIDELITY CARE MANAGEMENT
Entity Type:Organization
Organization Name:FIDELITY CARE MANAGEMENT
Other - Org Name:MIDTOWN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-927-2001
Mailing Address - Street 1:2001 POLK ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4539
Mailing Address - Country:US
Mailing Address - Phone:954-927-2001
Mailing Address - Fax:954-927-2001
Practice Address - Street 1:2001 POLK ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4539
Practice Address - Country:US
Practice Address - Phone:954-927-2001
Practice Address - Fax:954-927-2001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIDELITY CARE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6508310400000X, 3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness