Organization
FIDELIS SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS L EDGAR (OWNER/QDDP)
(573) 424-4367
Entity
Organization
Contact information
Practice address
3905 FAUROT DR, COLUMBIA, MO 65203-0309
(573) 424-4367
Mailing address
3905 FAUROT DR, COLUMBIA, MO 65203-0309
(573) 424-4367
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/10/2010
Last updated
09/10/2010
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