Fidelis One LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL5516 Issued in OK

Legal business name

FIDELIS ONE LLC

Practice address

4825 NW 23Rd St
Oklahoma City, OK 73127

Phone

(405) 945-0010

Fax

(405) 947-6542

NPI assigned

Aug 21, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shantharam Darbe

Title

Owner/Manager

Phone

(405) 840-9991

Specialties & licenses 1

Addresses

Other names 1

• Fidelis Assisted Living and Memory Care Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345766400000",
    "number": "1104174267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 N CLASSEN BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73118",
            "telephone_number": "405-840-9991",
            "fax_number": "405-840-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4825 NW 23RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73127",
            "telephone_number": "405-945-0010",
            "fax_number": "405-947-6542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIDELIS ONE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-21",
        "last_updated": "2012-08-24",
        "status": "A",
        "authorized_official_last_name": "DARBE",
        "authorized_official_first_name": "SHANTHARAM",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "405-840-9991"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OK",
            "license": "AL5516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fidelis Assisted Living and Memory Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Assisted Living Facility in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Assisted Living Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.