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General NPI Number Information
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NPI Number | 1639883077
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Entity Type | Organization
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Legal Business Name | FIDELITY SENIOR CARE LLC
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 1 OLD COUNTRY RD
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City | CARLE PLACE
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State | NY
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Zip | 11514-1801
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Country | US
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Telephone | 516-388-7277
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Fax | 718-702-2241
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Provider Business Mailing Address
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Address Line | 1 OLD COUNTRY RD
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City | CARLE PLACE
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State | NY
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Zip | 11514-1801
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Country | US
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Telephone | 516-388-7277
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Fax | 718-702-2241
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Authorized Official
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Title or Position | OWNER
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Name | SIMONE GALLOWAY
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Credential |
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Telephone | 516-388-7277
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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