Provider Demographics
NPI:1750959268
Name:FIDELITY ADULT CARE LLC
Entity type:Organization
Organization Name:FIDELITY ADULT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIREGEYA
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:207-653-5765
Mailing Address - Street 1:35 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4003
Mailing Address - Country:US
Mailing Address - Phone:207-653-7565
Mailing Address - Fax:
Practice Address - Street 1:35 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4003
Practice Address - Country:US
Practice Address - Phone:207-653-7565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-12
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities