Provider Demographics
NPI:1336787191
Name:FIDELITY HOME AND HOSPICE LLC
Entity Type:Organization
Organization Name:FIDELITY HOME AND HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NNEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOH GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-400-7073
Mailing Address - Street 1:2257 WHITE ROCK LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5891
Mailing Address - Country:US
Mailing Address - Phone:972-400-7073
Mailing Address - Fax:
Practice Address - Street 1:2257 WHITE ROCK LN
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5891
Practice Address - Country:US
Practice Address - Phone:972-400-7073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based