Provider Demographics
NPI:1952162935
Name:FOTIM LLC
Entity Type:Organization
Organization Name:FOTIM LLC
Other - Org Name:FOTIM LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOLUKE
Authorized Official - Middle Name:OLUBUNMI
Authorized Official - Last Name:ADELEKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-325-8849
Mailing Address - Street 1:11601 BRIGIT CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4487
Mailing Address - Country:US
Mailing Address - Phone:130-132-5884
Mailing Address - Fax:
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE STE 250
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8344
Practice Address - Country:US
Practice Address - Phone:301-325-8849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health