Provider Demographics
NPI:1568918274
Name:FORTUNE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:FORTUNE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-357-1354
Mailing Address - Street 1:6300 HESTON TERRACE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3075
Mailing Address - Country:US
Mailing Address - Phone:301-357-1354
Mailing Address - Fax:240-558-3483
Practice Address - Street 1:6300 HESTON TERRACE
Practice Address - Street 2:SUITE A
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3075
Practice Address - Country:US
Practice Address - Phone:301-357-1354
Practice Address - Fax:240-558-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14120071251C00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services