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General NPI Number Information
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NPI Number | 1689286288
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Entity Type | Organization
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Legal Business Name | FIDELITY HOME HEALTH CARE AGENCY LLC
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 20247 CREEKDALE BEND DR
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City | CYPRESS
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State | TX
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Zip | 77433-7475
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Country | US
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Telephone | 281-213-2944
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Fax | 281-213-2944
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Provider Business Mailing Address
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Address Line | 15050 COPPER GROVE BLVD APT 814
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City | HOUSTON
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State | TX
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Zip | 77095-2462
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Country | US
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Telephone | 281-213-2944
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Fax | 281-213-2944
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SIMON NDIFON
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Credential |
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Telephone | 408-401-1647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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