| Fidelity Community Support Group, Inc | |
|
4324 S Alston Ave Ste 203 Durham NC 27713-5296 | |
| (919) 806-0009 | |
| (919) 806-1201 |
| Full Name | Fidelity Community Support Group, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4324 S Alston Ave Ste 203, Durham, North Carolina |
| Authorized Official Name and Position | Jim Osita Okeke (CEO/OWNER) |
| Authorized Official Contact | 9198060009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fidelity Community Support Group, Inc 4324 S Alston Ave Ste 203 Durham NC 27713-5296 Ph: (919) 806-0009 | Fidelity Community Support Group, Inc 4324 S Alston Ave Ste 203 Durham NC 27713-5296 Ph: (919) 806-0009 |
| NPI Number | 1205132412 |
|---|---|
| Provider Enumeration Date | 02/04/2011 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1355595182 |
|---|---|
| Medicare Enrollment ID | O20130204000164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205132412 | NPI | - | NPPES |
| Provider Name | Carmen P Masullo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639229511 PECOS PAC ID: 2961502521 Enrollment ID: I20070711000595 |
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