Provider Demographics
NPI:1679139398
Name:T. C. FITZGERALD INC.
Entity type:Organization
Organization Name:T. C. FITZGERALD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:702-496-6906
Mailing Address - Street 1:335 W SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7700
Mailing Address - Country:US
Mailing Address - Phone:702-396-6906
Mailing Address - Fax:
Practice Address - Street 1:335 W SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7700
Practice Address - Country:US
Practice Address - Phone:702-396-6906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005053861Medicaid