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General NPI Number Information
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NPI Number | 1326376229
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Entity Type | Organization
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Legal Business Name | FIDELITY HEALTH CARE INC
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 3112 W 95TH ST SUITEB
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2405
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Country | US
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Telephone | 708-423-2100
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Fax | 708-423-2101
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Provider Business Mailing Address
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Address Line | 3112 W 95TH ST SUITEB
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2405
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Country | US
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Telephone | 708-423-2100
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Fax | 708-423-2101
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JORDAN T MORA
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Credential |
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Telephone | 708-423-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010802
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License Number State | IL
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