Provider Demographics
NPI:1326376229
Name:FIDELITY HEALTH CARE INC
Entity Type:Organization
Organization Name:FIDELITY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-423-2100
Mailing Address - Street 1:3112 W 95TH ST
Mailing Address - Street 2:SUITEB
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2405
Mailing Address - Country:US
Mailing Address - Phone:708-423-2100
Mailing Address - Fax:708-423-2101
Practice Address - Street 1:3112 W 95TH ST
Practice Address - Street 2:SUITEB
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2405
Practice Address - Country:US
Practice Address - Phone:708-423-2100
Practice Address - Fax:708-423-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010802251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health