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General NPI Number Information
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NPI Number | 1699181024
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Entity Type | Organization
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Legal Business Name | FIDELITY HOME CARE AGENCY
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 403 JUNIPER ST
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City | SAN ANTONIO
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State | TX
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Zip | 78223-4376
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Country | US
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Telephone | 210-716-7416
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Fax | 184-569-8396
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Provider Business Mailing Address
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Address Line | 403 JUNIPER ST
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City | SAN ANTONIO
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State | TX
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Zip | 78223-4376
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Country | US
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Telephone | 210-716-7416
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Fax | 184-569-8396
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VALEEN GUZMAN
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Credential |
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Telephone | 210-716-7416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 016050
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 016050
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 016050
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License Number State | TX
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