Healthcare Provider Details

I. General information

NPI: 1326376229
Provider Name (Legal Business Name): FIDELITY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 W 95TH ST SUITEB
EVERGREEN PARK IL
60805-2405
US

IV. Provider business mailing address

3112 W 95TH ST SUITEB
EVERGREEN PARK IL
60805-2405
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-2100
  • Fax: 708-423-2101
Mailing address:
  • Phone: 708-423-2100
  • Fax: 708-423-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1010802
License Number StateIL

VIII. Authorized Official

Name: MS. JORDAN T MORA
Title or Position: PRESIDENT
Credential:
Phone: 708-423-2100