Provider Demographics
NPI:1356562060
Name:FIDELITY HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:FIDELITY HOME HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:NOSIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-771-5277
Mailing Address - Street 1:9894 BISSONNET ST STE 585
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8251
Mailing Address - Country:US
Mailing Address - Phone:713-771-5277
Mailing Address - Fax:713-771-5278
Practice Address - Street 1:9894 BISSONNET ST STE 585
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8251
Practice Address - Country:US
Practice Address - Phone:713-771-5277
Practice Address - Fax:713-771-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011357251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015915Medicaid
TX001015357Medicaid