Healthcare Provider Details

I. General information

NPI: 1225415185
Provider Name (Legal Business Name): FIDELITY HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 S PECOS RD SUITE 100B
LAS VEGAS NV
89120-1289
US

IV. Provider business mailing address

5250 S PECOS RD SUITE 100B
LAS VEGAS NV
89120-1289
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-4442
  • Fax: 702-912-4443
Mailing address:
  • Phone: 702-912-4442
  • Fax: 702-912-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNVS8121HHA
License Number StateNV

VIII. Authorized Official

Name: MARIA JUDITA G QUANO
Title or Position: MEMBER
Credential:
Phone: 702-912-4442