MEDICARE: ALLIANCE FIDELEITY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	550000929	CA

General Provider Information

NPI Number	:	1538353289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE FIDELEITY CORPORATION

Provider Business Mailing Address
First Line	:	415 E HARVARD ST
Second Line	:	SUITE 202
City	:	GLENDALE
State	:	CA
Zip	:	91205-1057
Country	:	US
Telephone Number	:	818-247-5808
Fax Number	:	818-500-8075

Provider Business Practice Location Address
First Line	:	415 E HARVARD ST
Second Line	:	SUITE 202
City	:	GLENDALE
State	:	CA
Zip	:	91205-1057
Country	:	US
Telephone Number	:	818-247-5808
Fax Number	:	818-500-8075

Authorized Official
Title or Position	:	CEO
Name	:	BABAK KAMKAR
Credential	:
Telephone Number	:	818-247-5808

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	10/10/2012

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