Healthcare Provider Details

I. General information

NPI: 1578333035
Provider Name (Legal Business Name): FIDELITY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7467 BURTON DR
LIBERTY TOWNSHIP OH
45044-9030
US

IV. Provider business mailing address

7467 BURTON DR
LIBERTY TOWNSHIP OH
45044-9030
US

V. Phone/Fax

Practice location:
  • Phone: 513-497-8095
  • Fax:
Mailing address:
  • Phone: 513-497-8095
  • Fax:

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: FIDELE KOUMANIMBEN
Title or Position: CEO
Credential: RN, BSN
Phone: 513-497-8095