Provider Demographics
NPI:1760774400
Name:FADMO HHC
Entity Type:Organization
Organization Name:FADMO HHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KUNJUMOL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHILIPOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-599-3598
Mailing Address - Street 1:44 POLAND PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 POLAND PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5403
Practice Address - Country:US
Practice Address - Phone:347-599-3598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301252-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health