Provider Demographics
NPI:1144085242
Name:FRUITFUL HEALTHCARE SL
Entity type:Organization
Organization Name:FRUITFUL HEALTHCARE SL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ABU BAKARR GEORGE
Authorized Official - Middle Name:BOCKARE
Authorized Official - Last Name:SILLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-598-3311
Mailing Address - Street 1:5731 URBANDALE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1271
Mailing Address - Country:US
Mailing Address - Phone:614-598-3311
Mailing Address - Fax:
Practice Address - Street 1:5731 URBANDALE AVE STE 3
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1271
Practice Address - Country:US
Practice Address - Phone:614-598-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty