Healthcare Provider Details

I. General information

NPI: 1417767195
Provider Name (Legal Business Name): FIDELITY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 MAIN ST
COLUMBIA SC
29201-2820
US

IV. Provider business mailing address

1708 MAIN ST
COLUMBIA SC
29201-2820
US

V. Phone/Fax

Practice location:
  • Phone: 803-261-0742
  • Fax:
Mailing address:
  • Phone: 803-261-0742
  • 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: MR. CLARENCE PATRICK FOWLER
Title or Position: OWNER
Credential: OWNER
Phone: 803-261-0742