Provider Demographics
NPI:1801322664
Name:FORTUNE HEALTHCARE INC.
Entity type:Organization
Organization Name:FORTUNE HEALTHCARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:OBELEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-714-7526
Mailing Address - Street 1:6321 GREENBELT RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2352
Mailing Address - Country:US
Mailing Address - Phone:202-714-7526
Mailing Address - Fax:301-249-9627
Practice Address - Street 1:6321 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2352
Practice Address - Country:US
Practice Address - Phone:202-714-7526
Practice Address - Fax:301-249-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4237609-00251S00000X
MDR3778251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4237609-00OtherCFC/CO/CPAS
MDR3778OtherRESIDENTIAL SERVICE AGENCY