Provider Demographics
NPI:1013087618
Name:FORTUNE HEALTHCARE, INC
Entity Type:Organization
Organization Name:FORTUNE HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ATIF
Authorized Official - Middle Name:S
Authorized Official - Last Name:FATTAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-771-0032
Mailing Address - Street 1:2825 WILCREST DR
Mailing Address - Street 2:STE 312
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3391
Mailing Address - Country:US
Mailing Address - Phone:713-771-0032
Mailing Address - Fax:832-201-6739
Practice Address - Street 1:2825 WILCREST DR
Practice Address - Street 2:STE 312
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3391
Practice Address - Country:US
Practice Address - Phone:713-771-0032
Practice Address - Fax:832-201-6739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12517251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679727OtherMEDICARE - HOME HEALTH
TX=========OtherEMPLOYER ID NUMBER
TX741533OtherMEDICARE - HOSPICE