Provider Demographics
NPI:1063035574
Name:FIDELITY HOME CARE INC
Entity Type:Organization
Organization Name:FIDELITY HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALERGANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-675-3981
Mailing Address - Street 1:414 HACKENSACK AVE APT 2420
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6339
Mailing Address - Country:US
Mailing Address - Phone:201-675-3981
Mailing Address - Fax:
Practice Address - Street 1:1829 E 13TH ST STE 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2887
Practice Address - Country:US
Practice Address - Phone:718-524-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2734L001OtherLHCSA LICENSE