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General NPI Number Information
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NPI Number | 1538353289
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Entity Type | Organization
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Legal Business Name | ALLIANCE FIDELEITY CORPORATION
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 415 E HARVARD ST SUITE 202
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City | GLENDALE
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State | CA
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Zip | 91205-1057
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Country | US
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Telephone | 818-247-5808
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Fax | 818-500-8075
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Provider Business Mailing Address
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Address Line | 415 E HARVARD ST SUITE 202
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City | GLENDALE
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State | CA
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Zip | 91205-1057
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Country | US
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Telephone | 818-247-5808
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Fax | 818-500-8075
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Authorized Official
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Title or Position | CEO
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Name | BABAK KAMKAR
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Credential |
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Telephone | 818-247-5808
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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 | 550000929
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License Number State | CA
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