Provider Demographics
NPI:1023881075
Name:FIDELITY HOME HEALTHCARE, INC
Entity type:Organization
Organization Name:FIDELITY HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMENKY DOH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-675-8633
Mailing Address - Street 1:108 FARMGATE LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5759
Mailing Address - Country:US
Mailing Address - Phone:703-675-8633
Mailing Address - Fax:240-280-1918
Practice Address - Street 1:2 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-1866
Practice Address - Country:US
Practice Address - Phone:240-264-6846
Practice Address - Fax:240-280-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health