Healthcare Provider Details

I. General information

NPI: 1316285810
Provider Name (Legal Business Name): FIDELITY HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 VALLEY FAIR ST STE 102
SIMI VALLEY CA
93063-2954
US

IV. Provider business mailing address

4225 VALLEY FAIR ST., SUITE 102
SIMI VALLEY CA
93063-4225
US

V. Phone/Fax

Practice location:
  • Phone: 805-520-7600
  • Fax: 805-426-8989
Mailing address:
  • Phone: 805-520-7600
  • Fax: 805-426-8989

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: INGA HAKHUMYAN
Title or Position: CEO
Credential: CEO
Phone: 805-520-7600