Provider Demographics
NPI:1649045733
Name:FIJI PRIME IN-HOME CARE
Entity type:Organization
Organization Name:FIJI PRIME IN-HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TITILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-889-9505
Mailing Address - Street 1:725 FARMERS LN STE 6
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6742
Mailing Address - Country:US
Mailing Address - Phone:707-889-9505
Mailing Address - Fax:
Practice Address - Street 1:725 FARMERS LN STE 6
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6742
Practice Address - Country:US
Practice Address - Phone:707-889-9505
Practice Address - Fax:707-852-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care