Provider Demographics
NPI:1053525006
Name:FDN ENTERPRISES LLC
Entity type:Organization
Organization Name:FDN ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO-CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:NKANSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-312-5222
Mailing Address - Street 1:1766 FM 967 STE B
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2985
Mailing Address - Country:US
Mailing Address - Phone:512-312-2222
Mailing Address - Fax:
Practice Address - Street 1:1766 FM 967
Practice Address - Street 2:SUITE B
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2984
Practice Address - Country:US
Practice Address - Phone:512-312-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FDN ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008988251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453125Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER