Healthcare Provider Details

I. General information

NPI: 1174195481
Provider Name (Legal Business Name): FIDELITE HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15053 VENTURA BLVD STE 202A
SHERMAN OAKS CA
91403-2498
US

IV. Provider business mailing address

15053 VENTURA BLVD STE 202A
SHERMAN OAKS CA
91403-2498
US

V. Phone/Fax

Practice location:
  • Phone: 818-916-3962
  • Fax: 818-916-3962
Mailing address:
  • Phone: 818-916-3962
  • Fax: 818-916-3962

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: SOFYA POGHOSYAN
Title or Position: CEO
Credential:
Phone: 818-916-3962