Provider Demographics
NPI:1639883077
Name:FIDELITY SENIOR CARE LLC
Entity Type:Organization
Organization Name:FIDELITY SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-388-7277
Mailing Address - Street 1:1 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1801
Mailing Address - Country:US
Mailing Address - Phone:516-388-7277
Mailing Address - Fax:718-702-2241
Practice Address - Street 1:1 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1801
Practice Address - Country:US
Practice Address - Phone:516-388-7277
Practice Address - Fax:718-702-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health