Provider Demographics
NPI:1902533144
Name:FIDEM HOME CARE LLC
Entity Type:Organization
Organization Name:FIDEM HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:PHIRI
Authorized Official - Last Name:IERVOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-324-6365
Mailing Address - Street 1:8500 EAST MISSISSIPI AVE
Mailing Address - Street 2:UNIT 82
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2247
Mailing Address - Country:US
Mailing Address - Phone:720-324-6365
Mailing Address - Fax:
Practice Address - Street 1:8500 EAST MISSISSIPI AVE
Practice Address - Street 2:UNIT 82
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2247
Practice Address - Country:US
Practice Address - Phone:720-324-6365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities