Provider Demographics
NPI:1831336221
Name:FIDELITY COMMUNITY SUPPORT GROUP INC
Entity type:Organization
Organization Name:FIDELITY COMMUNITY SUPPORT GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:OSITA
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF HEALTH ADM
Authorized Official - Phone:919-201-8914
Mailing Address - Street 1:4535 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1831
Mailing Address - Country:US
Mailing Address - Phone:919-201-8914
Mailing Address - Fax:
Practice Address - Street 1:2327 ENGLERT DR
Practice Address - Street 2:SUITE 306
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4446
Practice Address - Country:US
Practice Address - Phone:919-806-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health