Provider Demographics
NPI:1144569849
Name:FIDELITY HOME HEALTH LLC
Entity Type:Organization
Organization Name:FIDELITY HOME HEALTH LLC
Other - Org Name:HOME CARE AGENCY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUZNETSOV
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:215-710-0515
Mailing Address - Street 1:83 BUSTLETON PIKE UNIT C
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6465
Mailing Address - Country:US
Mailing Address - Phone:215-710-0515
Mailing Address - Fax:215-710-0258
Practice Address - Street 1:139 BUSTLETON PIKE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6467
Practice Address - Country:US
Practice Address - Phone:215-710-0515
Practice Address - Fax:215-710-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04880501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102852380Medicaid
PA398201Medicare Oscar/Certification