Healthcare Provider Details

I. General information

NPI: 1639883077
Provider Name (Legal Business Name): FIDELITY SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OLD COUNTRY RD
CARLE PLACE NY
11514-1801
US

IV. Provider business mailing address

1 OLD COUNTRY RD
CARLE PLACE NY
11514-1801
US

V. Phone/Fax

Practice location:
  • Phone: 516-388-7277
  • Fax: 718-702-2241
Mailing address:
  • Phone: 516-388-7277
  • Fax: 718-702-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SIMONE GALLOWAY
Title or Position: OWNER
Credential:
Phone: 516-388-7277