Healthcare Provider Details

I. General information

NPI: 1295178432
Provider Name (Legal Business Name): FIDELITY HEALTH CARE & MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16753 CARRINGTON DR
SOUTH HOLLAND IL
60473-4611
US

IV. Provider business mailing address

16753 CARRINGTON DR
SOUTH HOLLAND IL
60473-4611
US

V. Phone/Fax

Practice location:
  • Phone: 773-573-9961
  • Fax:
Mailing address:
  • Phone: 773-573-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CATHRYN D WILLIAMS
Title or Position: C.E.O
Credential:
Phone: 773-573-9961