Healthcare Provider Details

I. General information

NPI: 1720647498
Provider Name (Legal Business Name): FIDELIS HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 E OLIVE AVE UNIT 101
BURBANK CA
91502-1215
US

IV. Provider business mailing address

358 E OLIVE AVE UNIT 101
BURBANK CA
91502-1215
US

V. Phone/Fax

Practice location:
  • Phone: 747-265-0668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ARTAK KHACHIKYAN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 747-265-0668